Love for the people of Pakistan

When the father of the nation Quaid-e-Azam Muhammad Ali Jinnah was requested to grace this hospital (formely Pakistan Central Hospital for government servents) by given his name, to which he agreed on one condition. He asked that “this hospital should also provide health care faculties to the common people along with central government servants”. This shows his love for the people of Pakistan.

Messages Academic Council & Organizing Committees Obituary Departmental Annual Activities

Symposium
Inauguration and plenary session Scientific Program Abstracts

Messages

Honorable Mr. Asif Ali Zardari
President Islamic Republic of Pakistan
I am pleased to learn that Jinnah Postgraduate Medical Centre Karachi, is holding its 47th Annual Medical Symposium. JPMC shall always remain to hold the honour of being the pioneer in initiating medical symposia. It has been holding symposia for the last 46 years while all other national symposia and conferences took decades to develop academic gala of such high standards. JPMC has a remarkable history and has contributed substantially towards the advancement of medical education, research & health care services. It has the honor of producing the largest number of specialists in basic and clinical sciences, nursing and paramedics as well as physical therapists who are serving both nationally as well as internationally. The government has focused its attention on providing adequate facilities to this institution in the field of research and education as JPMC has a major role to play towards the promotion of health care in the country. I wish the organizers a successful symposium for the noble cause of contributing to medical education & research. May Allah the Almighty be with us in our endeavors.

Honorable Mr. Syed Yusuf Raza Gilani
Prime Minister Islamic Republic of Pakistan
It is a pleasure to write this message on the occasion of the 47th Annual Medical Symposium of Jinnah Postgraduate Medical Centre Karachi. I congratulate the team for organizing such an auspicious occasion and am sure that the participants will share their experience, expertise, wisdom and knowledge in the hopes of benefiting and serving humanity. With massive advancement in the field of information and communication technology, there has been a mammoth explosion in scientific knowledge and harnessing this knowledge has become a major issue on an individual level. Symposia, conferences and clinical meetings offer the most reliable source for sharing knowledge, experience and research and unless this knowledge is understood or utilized for the benefit of humanity, it has little meaning. I wish the organizers and delegates of the 47th Annual Medical Symposium the success they deserve now and in future.

Honorable Mr. Makhdoom Shahabuddin
Federal Minister for Health Islamabad
It is indeed an honor to write this message for the 47th Annual Medical Symposium of Jinnah Postgraduate Medical Centre Karachi. JPMC is Pakistan’s premier health institution where teaching, training, research and care go hand in hand. It is also a breeding ground for healthy ideas and skills. The Annual Symposia held at JPMC have always reflected the high ends of this great institution. I am proud of JPMC and pray that this symposium will also maintain its high standards and provide great opportunities for Pakistani physicians and surgeons to exchange the results of their research among themselves, as well as with international physicians and surgeons.

Honorable Dr. Mahreen Razzaque Bhutto
Parliamentary Secretary for Health Islamabad
It is an honour for me to write this message for an institute that’s named after the father of this nation, Quaid-e-Azam Mohammad Ali Jinnah. The event is a prestigious gathering of luminaries in the field of medical science, providing an excellent opportunity to share knowledge and new ideas. No society can progress without giving priority to research and the quest for new knowledge. JPMC stands tall as the premier medical institute of Pakistan and a seat of advanced learning in medical sciences. It is my firm belief that symposia highlight problems and seek solutions for them. I congratulate the organizers, Executive Director and her team for holding the symposium.

Mr. Khushnood Akhtar Lashari
Federal Secretary for Health Islamabad
It is a pleasure to note that the 47th Annual medical symposium of JPMC Karachi is being held in the month of February 2010. Regular symposia at JPMC have always remained the focus of academic events ever since it was declared the first postgraduate institution of Pakistan in 1957. Symposia and conferences highlight the achievements in the field of medicine and surgery and provide an opportunity to update ourselves as to the latest frontiers of knowledge, and to present one’s own experience and research in various fields of medicine and surgery. This especially provides an opportunity to the junior consultants and postgraduates to interact with their seniors to improve themselves. I congratulate the organizers and encourage them to promote the services of nursing, paramedics and medical technologists, and to improve these services with knowledge sharing and by presenting research in their fields. I wish the organizers a successful and fruitful symposium.

Prof. Rashid Jooma
Director General Health Islamabad
It is a matter of immense pleasure to see the 47th Annual Medical Symposium of Jinnah Postgraduate Medical Centre being held as a hallmark of academic achievements of this Centre. JPMC took a lead in history of symposia in Pakistan. Leading health professionals have been invited to speak in the symposium to share their experience, present clinical analysis, propose solutions and suggest ways and means in the best interest of suffering humanity. My relation with JPMC has been for over sixty years and I am the witness that JPMC Symposia used to be the sole forum for doctors from all over Pakistan to feel privileged presenting their genuine work. Doctors from all over the world come to attend these symposia on a regular basis. Since then I have seen many symposia held in JPMC. Nothing stays at a plateau; it oscillates either going up or losing standards. I hope that this symposium will not only be a revival of its initial legacy but even take it further to achieve higher level of competency. I am sure that getting together and sharing knowledge will bring about very useful updating of scientific knowledge along with social interaction. This will definitely help all of us to improve our performance in patient care. I sincerely thank the organizers for making this event reproductive.

Prof. Tasnim Ahsan
Executive Director Jinnah Postgraduate Medical Centre Karachi
It’s a matter of great joy and pride for me to be writing this message on the auspicious occasion of the 47th consecutive symposium of Jinnah Postgraduate Medical Centre. This institution enjoys the distinctive position of initiating all postgraduate medical education in this country, and is a pioneer in holding scientific meetings at the postgraduate medical level. The JPMC Symposium marks the culmination of a year of academics and research. It is a time to take stock of all that matters - not only pertaining to education but also all aspects of patient care activities. This is also an opportunity for the JPMC staff to showcase their work for other institutions in the public as well as private sector, and also provides an opportunity to summarize our work output for the Federal Ministry of Health. We look forward to listening to the work of our colleagues from other institutions, and learning mutually from this interaction. There are some distinctive innovations in the forthcoming symposium which will set it apart from previous symposia, and hopefully, this wind of change will prove more successful. I wish the symposium organizers a very successful week of scientific exchange, and look forward to participating in it.

Prof. Ghulam Mehboob
Chairman Symposium Organizing Committee
It is a matter of pleasure for me to welcome participants of 47th Annual Medical Symposium. The JPMC has privilege to be the pioneer of holding clinical symposia/ conferences in Pakistan and this symposium is held regularly for last 47 years. I hope that this symposium is going to be a great success. Prof. Tariq Mahmood has come with innovative idea for change in the format of the symposium. The theme of Symposium this year is “Role of Symposia in Education and Research”. The purpose of this theme is to analyze scientifically the contribution of these activities in education and research and to have a critical review of the importance of symposium. I hope this will go a long way to suggest change to improve the standard of symposia. This year, we have decided to deviate from usual manner of holding the symposium and decided to entrust each discipline to hold their sessions independently. The activity is going to last for 8 days. I am grateful to Prof. Tariq Mahmood for taking deep interest and all the hard work he has put in making the event success. I am also thankful to Executive Director, Members of the Academic Council, and every one who has helped to make this symposium, a success.

Prof Tariq Mahmood
Secretary Symposium Organizing Committee
This modern era brings far better understanding of medical diseases and the rate of advancements in medical technology and revolutions in investigative and treatment modalities demands that the health care providers keep pace with these ever changing new trends through Continued Medical Education (CME). An ongoing phenomenon of research is essential to find new answers and solutions. Medical Symposia provide forum to health care professionals to present their work and findings, share their experiences and make recommendations. Improvements in the healthcare system, where requires measures to be taken by the government towards increasing health budget, making new hospitals, enhancing facilities to the existing setups with the aim of providing “Health for all”, it also demands empowering the health providers with the knowledge and skill to deliver this health to all, with excellence. Jinnah Postgraduate Medical Centre has been providing a forum for education and research for many years and it gives me immense pleasure to hold the 47th Annual Medical Symposium at Jinnah Postgraduate Medical Centre, Karachi from 15th February 2010 to 21st February 2010. This time, our theme of the symposium is "Role of Symposia in Education and Research”. JPMC being the pioneer in holding medical symposia in the country honors this challenge. It is our resolve in this 47th symposium to aim “Free Education for All”. We have taken a stand to promote education and not entertainment in this symposium. We have proudly made arrangements to accommodate and register 5825 participants free of cost and would acknowledge all the participation with mementos. We are happy to announce the inauguration of the new Najmuddin Auditorium Complex for all the upcoming activities. This year we have brought reform to the organization of this symposium by giving autonomy to every specialty so that they may conduct with liberty and responsibility their own activity according to their needs. We have given each discipline ample time and logistics dedicated to their specialty so that a maximum number of participants have the chance and space to acquire and enjoy this learning bonanza. Best free paper and poster would be awarded Gold Medals. There are 35 scientific sessions containing 84 invited talks, 218 free papers and 151 posters. We have also arranged 16 workshops in various specialties. CME hour accreditation would also be awarded. We have also published a souvenir for all our participants and the details will also be available on the JPMC web site under the name of 47th Annual Medical symposium. We wish this humble effort is an enlightening and an enjoyable experience for our participants. Thank you.

Academic Council & Organizing Committees

Academic Council of J.P.M.C – Karachi
Sitting First Row: Left to right. Prof, Anis Subhan, Prof. Azam J. Samdani, Prof. S.M. Tariq Rafi, Prof. Shereen Z. Bhutta, Prof. Tariq Mahmood, Prof. Tasnim Ahsan, Prof. Ghulam Mehboob, Prof. Kehmomal Karerra, Dr. Manohar Lal, Prof. Ahmed Usman Chaudhary, Prof. Nasir Khan Jakhrani, Sitting Second Row: Left to right. Dr. Sayed Waqar Ahmed, Prof. Mohammad Iqbal Afridi, Dr. Nasir Zaman Khan, Prof, Anisuddin Bhatti, Dr. Mohammed Azhar Chaudhry, Prof. Nagina Fatima, Prof. Nadeem Rizvi, Prof. Javed Hasan Niazi, Prof. Shaukat Ali, Prof. Abdul Sattar M.
Hashim, Prof. Saleem Ahmed Kharal. Members not in the photograph: Prof. Jamal Ara, Prof. S. M. Munir, Prof. G. Asghar Channa, Dr. Qazi Fasihuddin

Administration of J.P.M.C Sitting First Row: Left to right: Mrs. Zebunnisa, Mrs. Rehana Afghani, Dr. Seemin Jamali, Prof. Tasnim Ahsan, Prof, Ghulam Mehboob, Dr. Mohammed Zakaria, Dr. Mohammed Malook Bugti, Dr. Mohammed Azhar Khan. Sitting Second Row: Left to Right: Mr. Mohammed Akhter Anwar, Dr. Srichund V. Talib, Mr. Sharifullah Khan, Mr. Chaudhary Mohammed Akram, Mr. Mohammed Riaz Bhatti, Mr. Badaruddin Sheikh, Mr. Akber Ali Khan & Dr. Badar Jehan.

Academic Council of NICVD & Organizing Committee Sitting 1st row, 3rd from the left: Prof. Arif u Rehman, Prof. Khan Shah Zaman (Executive Director), Prof. Akhtar Hussain and organizing committee member Dr Zahid Jamal (4th from the left in 3rd row)

Members of Patients Aid Foundation, J.P.M.C. Left to right: Mrs. Maheen Bashir (Member), Mr. Zahid Bashir (Chairman BOG), Mrs. Shaheen Sulaiman (Gen. Secretary) Mr. Mushtaq Chapra (Chairman EC), Mr. Masood Shaikh (Member)

Session Wise Photographs

Organizing Committee of Ophthalmology Sitting First Row: 2nd from left Dr. Azad A. Sheikh, Dr. Alyscia M. Cheema, Prof. Javaid H. Rizvi, Dr. Vasdev Harani and other members

Organizing Committee of General Medicine Standing First Row: 2nd from left Dr. Muhammad Azhar Chaudhry, Dr. Liaquat Ali, Prof. Tasnim Ahsan, Prof. Jamal Ara, Dr. Rukhsana A. Sattar

Organizing Committee of Endocrine Session Standing First Row: 3rd from left Dr. Zeenat Banu, Dr. Umar Farooq, Dr. Shahbaz Haider and other members

Organizing Committee and Faculty of Chest Medicine Standing First Row: 4th from left Dr. Saifullah Baig, Prof. Nadeem Rizvi and other members

Organizing Committee & Faculty of Nephrology Standing Row: 3rd from left: Dr. Abdul Manan Junejo, Dr. Manohar Lal and other members

Organizing Committee of Paediatric Session Left to Right: Prof. S. Jamal Raza (Executive Director NICH), Dr. Jamshed Akhter (HOD Paeds Surgery)

Organizing Committee of General Surgery Standing Row: 2nd Left to right: Prof. Nasir Zaman Khan, Prof. Anis Subhan, Dr. Nisar Mangi, Dr. Shahid Rasool and Dr. Sagheer Hussain.

Organizing Committee of General Surgery Standing Row: 3RD Left to right: Prof. Nasir Zaman Khan, Dr. Nisar Mangi, Dr. Sagheer Hussain, Dr. Zia-u-Islam, Dr. Sughra Perveen and others.

Organizing Committee of Urology Sitting First Row: Left to right: Dr. Mansoor, Dr. Khalid Rasheed, Prof. Umar Baloch, Dr. Shahzad Ali and other members

Organizing Committee of Nephrology & Urology Sitting First Row: 2nd from left Dr. Abdul Manan Junejo, Dr. Manohar Lal, Prof. Mohammad Umer Baloch, Dr. Shahzad Ali and other members

Organizing Committee of Dermatology Standing First Row: 3rd from left Dr. Sobia Liaquat, Dr. Behram K. Khoso, Prof. Azam J. Samdani and other members

Organizing Committee & Faculty of B.M.S.I. Sitting First Row: Left to Right:. Dr. Naila Tariq, Dr. Shehnaz Kehar, Mrs. Nudrat Anwar Zuberi, Dr. Anjum Naqvi, Prof. Khemomal Karrera, Dr. A. Shakoor Memon 2nd Row Left to right: Dr. M. Azhar Khan, Dr. M. Asif Durrani, Prof. M. Umer Baloch, Prof. Saleem A. Kharal, Dr. Moosa Khan, Dr. M. Anwar, Dr. Suresh Kumar

Nursing Organizing Committee Standing First Row: 3rd from left Mrs. Zebunnisa, Mrs. Rehana Afghani and other members

Organizing Committee of Gynaecology and Obstetrics Standing Row: 2nd from left Dr. Halima Yasmeen, Dr. Razia Korejo, Prof. Shereen Z. Bhutta, Dr. Deedar A. Junejo, Prof. Nagina Fatima and other members

Organizing Committee of E.N.T Sitting First Row: 2nd from left Dr. Muhammad Usman, Prof. Tariq Rafi, Dr. Sameer Qureshi

Organizing Committee & Faculty of Neurosciences Standing First Row: Left to right Dr. Lal Rehman, Prof. M. Iqbal Afridi, Prof. A. Sattar M. Hashim, Prof. Shaukat Ali and other members

Organizing Committee & Faculty of Dentistry Standing First Row: 5th from left Dr. Abid Mehmood and his team

Organizing Committee of Orthopaedic Standing First Row: 3rd from left Dr. Irfanullah Ansari, Prof. Ghulam Mehboob, Prof. Anisuddin Bhatti and other members

A. R. Jamali

Members of Organizing Committee of Orthopedic Left to right: Dr. Khalid, Dr. Nasir, Dr. Salman and others

Organizing Committee & Faculty of Physical Medicine and Rehabilitation Standing First Row: 2nd from left Mr. Shahwar Mustafa, Dr. Irfanullah Ansari and other members

Organizing Committee & Faculty of Medical Oncology Standing First Row: 2nd from left Dr. Tehseen Khursheed, Dr. Heeranand, Prof. Ahmed Usman Chaudhry, Dr. Ghulam Haider and other members

Organizing Committee of Anesthesiology Sitting First Row: Left to right Dr. Nadeem Munir, Dr. Fauzia Ali, Dr. Capt. Amanullah Khan, Prof. Nasir Khan Jakhrani, Dr. Roohina Baloch and other members

Organizing Committee: & Faculty of Radiology Sitting First Row: Left to right Dr. Amber Paras, Dr. Najam ul Hasan, Dr. Nadira Abid, Dr. Saima Imran, Dr. Tasneem Butt, Prof. Tariq Mahmood, Prof. Zaffar Sajjad, Dr. Mohammed Salman & Other Members.

Organizing Committee of Department of Ultrasound/Color Doppler Sitting First Row: 3rd from left Dr. Saima Imran, Dr. Tasneem Butt, Dr. Mohammad Salman, Prof. Tariq Mahmood and other members

Faculty and Organizing Committee of Neuro Sciences From left to right: Dr. Tanoli, Prof. A Sattar Hashim, Prof. Shaukat Ali, Prof. Iqbal Afridi and Dr. Najam

Dedicated Workers Mr. Iqrar Ali Mr. Zaigum Ali

Organizing Committee of F.G. Officer Ward Dr. Arifa Akram (right)

Organizing Committee of A.D.M Office Sitting First Row: 2nd from left Mr. Iftikharuddin, Dr. Badar Jehan and other office workers

Organizing Committee of Security Guard Standing First Row: 2nd from left Mr. Akram Janjua, Mr. Badaruddin Sheikh and other security staff

Organizing Committee of Housekeeping Department Standing Row: 2nd from left Mr. Izhar Siddiqui, Mr. Badaruddin Sheikh and other staff members

Acknowledgment
Jinnah Postgraduate Medical Centre acknowledges the untiring efforts of the following in the preparation of the Souvenir for the 47th Annual Medical Symposium of JPMC 2010

Dr Raza Younus

Dr Samreen Iqbal

EMERITUS PROF. HASAN AZIZ
By Prof. Shaukat Ali Head of Neurology Department, JPMC

AN EPITOME OF DEDICATION & HUMANITARIAN SERVICE

Prof. Hasan Aziz, a pioneer of neurology in Pakistan and needs no introduction. It is extremely difficult to summarize his forty long years of achievements and dedicated service towards neurology in Pakistan in general and especially in Jinnah Postgraduate Medical Centre. A meritorious graduate of the Nishtar Medical College, Prof. Hasan Aziz proceeded to United Kingdom to be formally trained in Neurology. Turning down lucrative offers, he returned back to his homeland with a vision and spirit of developing the field of neurology in Pakistan. On his return in 1969 he joined the Jinnah Postgraduate Medical Centre, Karachi as Honorary Associate Physician and after about two decades of his singular pursuance he succeeded in the establishment of an independent Department of Neurology at JPMC. In his ongoing innings at JPMC, he has held varied posts including that of the Professor and Head of the Department of Neurology, Director JPMC, Chairman Academic Council, Chairman Continued Medical Education and presently Emeritus Professor of Neurology. Prof. Hasan Aziz has been a part of major neurology-based research projects of international standards conducted in Pakistan. To his credit are many published research papers, articles, monographs, book chapters, state of the art lectures both locally and internationally, His population-based study in epilepsy has been acknowledged internationally placing Pakistan on the international map of epilepsy. Under the helm of Prof. Hasan Aziz, the Department of Neurology, JPMC (DNJPMC) evolved from its initial days of one senior consultant and 3-5 junior doctors to a Department with full strength of consultants, residents and postgraduates. It was his farsightedness to introduce the Diploma in Clinical Neurology course along with MD & FCPS (Neurology) training at DNJPMC thus producing a somewhat respectable number of senior and middle grade neurologists in the country. To upgrade the fledgling department, he with the help of concerned doctors of DNJPMC initiated a CBR-exempted NGO, the which also supported research activities at the department. The present day neurology department is all due to the endeavors of Prof. Hasan Aziz. Neurology Research and Patient Welfare Fund (NRPWF) Prof. Hasan Aziz has a special passion towards epilepsy and the affected. It has become his lifetime challenge to bring a difference in the lives of people with epilepsy in Pakistan. His infectious spirit to help the underprivileged has caught on most of his associates resulting in formulation of a volunteer team running the all Pakistan-based Comprehensive Epilepsy Control Programme of Pakistan since 2001; a project conceived implemented and evolved under his supervision. His dream of establishing an iconic centre for people with epilepsy and providing grace in their management has been fulfilled in the form of the National Epilepsy Centre, at JPMC. His work in epilepsy has been acknowledged by the international community. In the past he has served as member of several sub-commissions of the International League Against Epilepsy and presently is a member of its Commission for Asian and Oceanian Affairs; a distinction unique to any Pakistani neurologist. It is a rare distinction to come across a person of Prof. Hasan Aziz’s caliber who has felt for the underprivileged people of our society and has dedicated his skills and influence to help provide better health facilities for them. His belief in the need of publicprivate partnerships and its success exemplified at DNJPMC has resulted in the initiation, execution and evolvement of several such projects at JPMC. Some projects at JPMC that he has been closely involved include construction of Najmuddin Auditorium Complex, construction of Labor Rooms / Gynae-Operation Theatre Project, construction of Medical Department (Ward No; 6) under the Medicine and Endocrine Foundation and the Accident and Emergency Foundation’s Emergency Operation Theatres Project. Other than these, he is a Trustee of The Jinnah Foundation and Hope Trust both working for the welfare of the underprivileged. The faculty and staff of Jinnah Postgraduate Medical Centre applaud the services of respectable Prof. Hasan Aziz; a skillful medical practitioner, a fatherly teacher, an internationally acknowledged researcher, a highly respected colleague, a social worker, and above all a compassionate human being.

Obituary

DR. SYED ABDUL MUJEEB
Associate Professor Blood Bank JPMC Karachi (Feb.12, 1957-Sep.6, 2009)
Syed Abdul Mujeeb acquired his medical degree from LMC Sindh University Jamshoro in 1983 and passed FPSC and joined JPMC as a Medical officer in the year 1984. Very soon he posted in the department of Blood Bank, which was the time when blood bank was totally depended on commercial blood donation then he made the aim for complete elimination of those bad practices not only from the blood bank JPMC but the whole country. His struggle became true with government support and non-governmental organization participation (PAF) to established country’s largest hospital based blood bank providing all basic facilities and services. In 1994 complete elimination of commercial blood donation in the blood bank JPMC by his weary efforts, gave him some sort of satisfaction. He did not stop here then he struggled for blood transfusion act in the country and successfully passed the safe blood transfusion act 1997 in Sindh Assembly. He always in searched for safe and quality blood supply to the patients for this he got external quality assurance program from NRL Australia since 1997 which is running uptil now. Dr. Mujeeb was the pioneer of establishing country’s first AIDS Surveillance Centre and HIV/AIDS Screening centre in the blood bank JPMC as early as 1986 and got the platform for diagnosis of first AIDS case in the country. He did M.Phil (Microbiology) in 1992(BMSI) and MSc (Epidemiology) from University of London in 2006. He had produced more than 60 scientific research papers which published in the International and National prestigious scientific journals. He also wrote more than 70 articles, pamphlets for specific and general public awareness. Dr. Mujeeb was the author of three books namely: Blood Transfusion: A technical and clinical care, AIDS Pandemic in Pakistan, HIV/AIDS in Pakistan. He continuously provided consultancies to W.H.O., UNAIDS, UNICEF, Government of Pakistan, Government of Sindh, Aga khan University Hospital, Population Council, Biological Committee MOH, govt. of Pakistan. Safe blood for safe motherhood (W.H.O) etc. For this he visited throughout the country and all over the world. President of Pakistan awarded him Presidential Award for “Pride of Performance” in 2007. Government of Pakistan, Government of Sindh, other National and International Public and community organization awarded him many appreciation awards for his giant work in the field of Blood transfusion, hepatitis infection and HIV/AIDS. It was his dream that our country become free from HIV/AIDS, Hepatitis and 100 percent voluntary blood donation in the country so that every recipient must get blood without providing exchange blood donor. Dr. Mujeeb was no doubt a towering personality. He died on 6th September 2009 and left behind a tall legacy of scientific work for others to further consolidate. He will always be remembered as a firm, assertive, ethical quietly efficient, kind hearted and yet a very compassionate person.

LATE MR. ABDUL HAQ
(Aug.31, 1951-May.20, 2009)
As per record held in this office Mr. Abdul Haq, Ex-Foreman born on 31.08.1951. He joined Government Service in JPMC as Shop Assitant on 26.09.1972. He was appointed as Metal Worker on 01.12.1976 and was promoted as Foreman (BS-14) on 08.10.1996. Unfortunately, he suffered a biatetic ailment and died during service on 20.05.2009. He rendered 36 years, 5 months and 24 days satisfactorily service in this Centre. He performed his services throughout in General Workshop where the following work is carried out:i. ii. iii. iv. v. vi. vii. Maintenance of Furniture (coordination) Patient wheel chairs Plumbering Carpentry Tin smithing/Black smithing Writing and painting of sign boards and banners Welding

During his entire service he was found punctual, honest and hard worker. Through the passage of his career in this centre, he acquainted himself with the variety of various machines, appliances and equipments. He was smart and energetic. In bereaved, he left behind his widow and 3 children. May God rest his soul ever in the eternal abode.

MR. HUKUM SHAH
Medical Technologist
Mr. Hukum Shah joined Jinnah Postgraduate Medical Centre in 1978. He was initially posted in the Department of Nephrology. He then was posted in National Institute of Child Health and Main Laboratory. He was transferred and posted again in department of Nephrology 6 years back, where he worked till his retirement on 4th June 2008. He was an efficient worker and dedicated person. He knew his subject well. He was cordial with colleagues and patients. May Almighty Allah rest his soul in peace.

Departmental Annual Activities

DEPARTMENT OF ACCIDENT & EMERGENCY
Faculty:
Dr. Seemin Jamali Joint Executive Director & Incharge Patient warming system- Snuggle warmers Airway devices- Laryngoscopes, tube changers, Percutaneous tracheostomy sets. The Accident and Emergency Department is also the nodal point of disaster management . It is fully equipped to handle any type of emergency and disaster and has resuscitation facilities round the clock. Consultants of other Medical and surgical departments take periodic rounds in the emergency. A malaria screening section caters to the diagnostic needs of patients suspected to have malaria in the A& E department , OPD and indoor patients of the hospital. The Emergency Department of the JPMC is amongst the pioneer units for Rabies Immunization and has established a Dog Bite Clinic meeting the WHO criteria , which has been worked successfully fot the last 18 years. This clinic provides free of cost treatment to at least 1200015000 patients annually in terms of vaccine and immunoglobulin. Besides the above, the department trains interns as well as post graduate doctors in the Emergency management of both medical and surgical conditions. The exposure is wide and training is supervised closely. This gives the trainees the much needed self confidence in dealing with emergent medical and surgical diseases and conditions. enormous number of people benefit from these facilities on a daily basis and precious lives are saved. However the load work on this department is tremendous and the resources are scanty. A statistical study of the last five years shows a meteoric rise in the load work whereas the man and material resources have not been augmented in the same proportion.

Accident and Emergency care is a specialty that involves the management of patients with life-threatening conditions , accidents, trauma and frequently complex medical and surgical illnesses. These patients may have dysfunction or failure of one or more organ systems, including the cardiac, pulmonary, neurologic, renal and hepatobiliary or gastrointestinal systems. Procedures used to help, support, stabilize and address the critical condition may include endotracheal intubation, central venous catheterization, arterial cannulation, pulmonary artery catheterization, bronchoscopy, lumbar puncture, thoracentesis, paracentesis, and chest tube thoracostomy. A modern Accident and Emergency care outfit represents the pinnacle of any hospital's approach to highly technological & sophisticated inpatient care. In Karachi , which has been declared the largest city of the world with a population in excess of 18 million, the JPMC Department of Accident and Emergency is one of the largest emergency medical service provider in Pakistan. This department is unique in its nature and quantum of work by virtue of its location in the heart of the populous city of Karachi and being a part of a multi disciplinary tertiary care hospital it has the capability of handling poly trauma and a multitude of other medical emergencies. Over the past two decades it has evolved from a conventional experience based Casualty Ward to an increasingly precise and scientifically based Accident and Emergency medical service provider. The department's mission is to provide an exceptionally high level of critical care & emergency services, and to maintain, and train a highly qualified staff of health care professionals devoted to the care of the critically ill. Built over an area of 18000sq. feet, the Accident and Emergency Department bears a very pleasant and aesthetic look. The Accident and Emergency Department is situated on the ground floor. It has triage area, consultation and examination area, observation ward, state of the art emergency operation theatre, closed reduction and plaster and dressing bay and doctors and staff rooms and patient waiting areas. All patient beds have piped gases, Central suction, Multichannel cardiac monitors, mobile ECG machines and resuscitation facilities. The patient area is divided into 15 critical care pods. The design was created keeping in mind the space utilization, patient comfort, infection control, and ease of providing critical care, nursing care and the functional requirements . This Unit has 100 beds for initial management and observation . The capacity can be expanded to 150 beds in modular form. All patient beds are equipped with Multichannel physiological monitoring systems, which allow close monitoring of patients both from the bedside and the central nursing station and the use of a variety of invasive and noninvasive modalities. To provide organ assessment and support, the Accident and Emergency Department has a variety of equipment like: Defibrillators Patient Monitors Central monitoring stations Pulse oxymeters Radiology equipment- X-ray machine- ultrasound- CT Scan MR ECG Infusion pumps

Year
2009 2008 2007 2006 2005

No. of Patients attended by A & E Department
277,184 206,920 193,400 202,901 189,833

The above figures indicate that on an average the A & E Department sees an average of 650 patients every day of the year. Similarly the statistics of dog bite cases shows a sharp increase over the last five years.

Year
2009 2008 2007 2006 2005

No. of Dog Bite cases
15,870 14,207 13,010 10,094 10,180

DEPARTMENT OF ANAESTHESIOLOGY & SURGICAL ICU
FACULTY:
4 Professor: 4 Assistant. Professors. Prof. Nasir Khan Jakhrani Dr. Roohina Baloch Dr. Fauzia Ali Dr. Nadeem Muneer Dr. Shoaib Malik Dr. A. Rahim Memon Dr. Tahir Amin Choudhary Eleven

Pain Clinic:
4 Services are provided for the management of patients suffering from chronic pain; examples include but not limited to Cancer Pain Sympathetic neuralgias. Phantum limb pain, etc.

Other services:
4 Services are provided for Placement of Endotracheal tubes in wards as well as in Accident and Emergency Department. Placement of central venous pressure lines. Cardiopulmonary resuscitation of patients. Placement of nasogastric tubes. Ventilator support guidance to various departments.

4 Senior Registrar 4 RMOs

FACILITIES: Operation theatres Elective surgeries
4 Eighteen operating rooms are functioning during working hours six days a week, where all sorts of scheduled operations are performed including. ü General surgery Ward-03 Ward-02 Ward-26 ü Orthopedic surgery ü Neuro & spinal Surgery ü Thoracic surgery ü Plastic surgery ü ENT surgery ü Urology ü Gynecology & Obstetrics ü Eye surgery Nine lists per week Seven lists per week Six lists per week Eight lists per week Nine lists per week Two lists per week Three lists per week Seven lists per week Two Lists per week Twelve lists per week Five lists per week

Anaesthetic Participation in Surgical Workshops:
4 Surgical Workshop on Colorectal disease was organized in Accident & Emergency Department from 16 -11-09 to 19-11-09.The anaesthetic team provided general anaesthesia & acute pain control to the patients undergoing surgical demonstration.

LIBRARY:4 Departmental library was established in 2002. Recent journals of Anaesthesiology and latest editions of reference books are available in the library.

TEACHING AND TRAINING ACTIVITES:4 Daily teaching rounds in SICU 4 Daily teaching and hands on training of undergraduates and postgraduates in operating rooms 4 Twice weekly presentations / lectures in class rooms 4 Morbidity & Mortality meeting twice monthly. 4 Case presentation / discussion , once weekly

Emergency surgeries:
4 Emergency Anaesthesia care services are provided round the clock seven days a week for all surgical specialties.

CONTINUOUS MEDICAL EDUCATION:
4 Workshop on” pain less delivery” was organized on 3rd Feb 2009. 4 The workshop consisted of lectures concerning anatomy, physiology, procedure and technique of epidural anaesthesia, followed by hands on training of epidural anaesthesia on a manrequin. 4 An Update on Anaesthesia was organized by the department of Anaesthesiology & SICU on 7th April, 2009 as part of 46th Annual Medical Symposium, JPMC. The theme for this update was “Current Challenges in Anaesthesia,Intensive Care and Pain management”. 4 Workshop on “Ventilatory modes in ICU” was organized by the department of Anaesthesiology on 8th April 2009. Workshop on” infection control in intensive care unit” was organized on 9th December 2009. The workshop consists of lectures regarding sterilization, disinfection and control of infection in ICU followed by hands on training on hand washing method, agents and equipment used for disinfection and sterilization .This workshop was very well attended by junior and senior doctors from surgical and medical faculty as well as paramedical staff of the hospital.

Statistics:
4 Total number of surgeries performed during the year 2009 from 1st January to 31st December are as follows: ü ü ü ü ü ü Main operation theatre (Elective & EOT ) 5958 (COT) 2456 Gynae & Obs (Elective &Emergency ) 4584 Ophthalmology 1000 ENT 1190 Urology 712

Surgical Intensive Care Unit:
4 A well equipped 07 bedded surgical intensive care unit works under the supervision of anaesthesia department. A variety of patients admitted who require intensive care, invasive monitoring, ventilatory support and multiple organ support e.g. cardiac, renal. nutritional support is also provided in SICU. 4 During the year 2009, a total of 540 patients were admitted in SICU.

DEPARTMENT OF ANATOMY, BMSI
FACULTIES:
Associate Professor/Incharge Assistant Professor Dr. Anjum Naqvi Nil 4. The Radio protective Role of Methycobal on Cerebellar Cortex of young Albino Rats. March 2009, Vol 20, No.3, 18-23 (Dr. Bashir Ahmed Shaikh & Dr. Anjum Naqvi). 5. To observe and compare the histological features of fat induced adrenal cortex in Albino Rats. April 2009, Vol 20, No.4,1013. (Dr. Iram Quddus & Dr. Anjum Naqvi). 6. Protective role of zinc in piroxicam induced hepatic lobule damage in mice. April 2009, Vol 20, No.4, 18-21. (Dr. Muhammad Nadeem Siddiqi & Dr. Anjum Naqvi). 4 Four Candidates, synopses for the degree of M. Phil Anatomy were submitted & accepted in 2008, they would appear in the coming forth examination of University of Karachi July, 2010. 1. Dr. Bashir Ahmed Shaikh: The Radio protective Role of Methycobal on Cerebellar Cortex of young Albino Rats. 2. Dr. Iram Quddus: Effect of Fat- induced stress on adrenal gland with Protective role of l-arginine in Albino Rats. 3. Dr. Hemant Kumar: Morphometeric Study of Heat-Induced Testicular damage with Protective role of Cyancobalamine in Albino Rats. 4. Dr. Abdul Hafeez: Immunological and Cytoprotective response of Cyancobalamine on Heat-induced Splenic Tissue in Albino Rats. 4 A batch of three candidates is in 2nd year M. Phil they are going to complete their course work. 4 A fresh batch of five candidates has started its course from 1st Sept 2009.

FACILITIES:
Anatomy Department is recognized for M.Phil and PhD by PM&DC and University of Karachi. Department is actively providing postgraduate education, training and research facilities leading to M.Phil& PhD degree. It also provides a forum for presentation of research papers. The Department is well equipped with modern research oriented equipments.

ACTIVITIES: (EDUCATIONAL & RESEARCH)
4 Presently there are thirteen (13) candidates in the Department of Anatomy. 4 All courses in the subject of Anatomy (Histology, Embryology Neuroanatomy, Micro technique, and Gross Anatomy) & examinations of all courses for internal assessment are conducted. 4 Weekly journal club for M. Phil candidates to plan carry out the research independently. 4 Weekly slide seminars are conducted for all post graduate trainees. 4 Subject (Anatomy course) topic presentation for learning & gaining teaching experience are also conducted. 4 Research for completion of M. Phil thesis is conducted & candidates are prepared for M. Phil final examination of University of Karachi. 4 Preliminary and final seminars are also conducted for submission of synopsis and thesis before appearing in University of Karachi examination. 4 Seven original papers from Anatomy Department have been presented at the 45th Annual Medical Symposium JPMC Karachi.

ACHIEVEMENTS:
4 Three candidates were declared successful in the Final M.Phil examination of the University of Karachi held in July 2009. 1. Dr. Muhammad Nadeem Siddiqi: The Morphometeric study of piroxicam induced Hepatic damage with protective role of Zinc in Mice. 2. Dr. Abdul Latif Panhwar: A Histological study of irradiated bones with Radio protective effects of somatotrophin and Ascorbic Acid in young Albino Rats. 3. Dr. Aisha Qamar: A Histological study of High Fat- treated Live with Fresh Garlic prevention in Albino Rats. 4 The Anatomy Department has published six original research papers in 2009. 1. Effect of radiation on growing long bones of young albino rats. Medical forum, Februrary2009, Vol 20, No.2, 3-7 (Dr.Abdul Latif Panhwar & Dr. Anjum Naqvi). 2. Effect of heat on testicular tissue with protective role of Cyancobalamine (Vitamin B12) in Albino Rats. Februrary 2009, Vol 20, No.2, 19-22. (Dr. Hemant Kumar & Dr. Anjum Naqvi). 3. Ameliorating role of fresh garlic on high–fat diet induced liver in Albino Rats. March 2009, Vol 20, No.3, 3-8. (Dr. Aisha Qamar & Dr. Anjum Naqvi).

DEPARTMENT OF BIOCHEMISTRY, BMSI
FACULTY:
4 4 4 4 Professor & Head Associate Professor Assistant Professor Medical Technologist :: :: :: :: Prof. Khemomal A. Karira Mrs. Nudrat Anwar Zuberi Dr Suresh Kumar Mr Muhammad Altaf 3. Two research papers were presented at 46th Annual Medical Symposium JPMC 2009. 4. Attended seminar “ Men’s Sexual Issues” organized by National Institute of Diabetes and Endocrinology, DUHS in collaboration with Professional Development Centre Karachi, held on 26th September, 2009 By Prof K. A. Karira. 5. Four publications of original research papers in 2009 6. Appointed as member of the Board of study for Biochemistry by LUMHS, Jamshoro 7. Reviewer of Medical Journal Recognized by PMDC 8. Conduct examination of postgraduate M.Phil candidates (total 86) and of undergraduate MBBS at various Medical Colleges/Universities 9. Prof. K. A. Karira received the “ Life Time Achievement Award” in 2009 from JPMC 10. Mrs Nudrat Anwar Zuberi provides services of Coordinator BMSI

FACILITIES
The Department of Biochemistry involvement in academic activities continues throughout the year and it provides training, teaching and research facilities to the students of M.Phil/Ph.D in addition to understand the research skills and preparation of synopsis, thesis and articles for publications. Provides teaching to students of Clinical Pathology Department. Also provides services of special tests to JPMC Hospital through the postgraduate students related to their research.

TEACHING ACTIVITIES
At present twenty ( Major 13 & 7 minor) postgraduate students are under going regular course in M.Phil Biochemistry, Basic Medical Sciences Institute, JPMC. Five candidates appeared in final university examination and declared pass in 2009, while research of 2 major students have been completed and likely to appear in July 2010 and research of four are underway on topics of clinical Biochemistry. Four have appeared in preliminary seminar and are preparing synopsis for submission to the university.

PUBLICATIONS
(A) Four publications of original research papers in 2009 and 11 in 2008. (B) One paper is under publication

DETAILS
1. Antioxidant vitamin E concentration and risk factors hypertension, diabetes mellitus and smoking in patients with coronary heart disease. Medical Channel 2008;14(2-II): 215-217. 2. Role of Diet in Type -2 Diabetes Mellitus. Medical Channel 2008; 14(2-II): 218-221. 3. Serum antioxidant vitamin E concentration and lipid profile in coronary heart disease (CHD) Patients. Medical Channel 2008; 14(2-II): 222-225. 4. Evaluation of testosterone levels of women with pre-eclampsia. Medical Channel 2008; 14(2-II): 226-229. 5. Thyroid function in relation to liver functions in apparently healthy subjects and in cirrhotic. Medical Channel 2008; 14(2-II): 230232. 6. Assessment of pulmonary functions in apparently healthy subjects and diabetics. Medical Channel 2008; 14(2-II): 233-35. 7. Elevated vascular endothelial growth factor in malignant ascites. Medical Channel 2008; 14(2): 6-9. 8. Serum magnesium status in patients with chronic heart failure. Medical Channel 2008; 14(3): 67-70. 9. Dyslipidemia in type 2 diabetes mellitus explaining more atherogenic in women. Medical Channel 2008; 14(3): 71-74. 10. Assessment of nutritional status in school going children in different socioeconomic groups. Medical Channel 2008; 14(3): 75-78. 11. Evaluation of serum Leptin levels during normal pregnancy and in pre-eclampsia. J Ayub Med Coll Abbottabad 2008 (Oct-Dec); 20(4): 137-140. 12. Serum antioxidant vitamin C concentration and lipid profile in coronary heart disease (CHD) patients. Medical Channel 2009; 15(2): 61-64. 13. Serum level of insulin, IGF-1 and PSA in prostate cancer patients in local population. Medical Channel 2009; 15(2): 68-71. 14. Heart failure patients are prone to develop magnesium deficiency as a result of diuretic/digoxin therapy. JDUHS 2009 (JanuaryApril); 3(1): 4-9. 15. Association of bone mineral density with urinary hydroxyproline and serum estrogen in postmenopausal women. Medical Channel 2009 (July September); 15(3): 112-114.

ACADEMIC ACTIVITIES
At present twenty ( Major 13 & 7 minor) postgraduate students are under going regular course in M.Phil Biochemistry, Basic Medical Sciences Institute, JPMC. Five candidates appeared in final university examination and declared pass in 2009, while research of 2 major students have been completed and likely to appear in July 2010 and research of four are underway on topics of clinical Biochemistry. Four have appeared in preliminary seminar and are preparing synopsis for submission to the university.

1. Orientation course includes instrumentation and organic chemistry to the newly admitted 2. Teaching regular course of Biochemistry to M.Phil students (major & minor). 3. Topic presentation to gain practical experience of teaching in Biochemistry. 4. Journal Club once a week to activate the students to plan carry out the research independently 5. Morning meeting of staff and students to discuss the daily progress 6. Weekly discussion on research progress and solve the problems of M.Phil students in connection to their research progress 7. Discussion on recent advancements in research related to Biochemistry quarterly 8. Course of informative Technology through computer in connection of locating articles and Biostatistics particularly for senior students.

ACHIEVEMENTS
Following achievements were carried out by Prof. K. A. Karira, faculty members and students 1. Five candidates declared passed M.Phil in 2009 under the supervision of Prof K. A. Karira 2. Being a member of APTAC, Ministry of Food, Agriculture & Livestock Islamabad, attending the meetings when invited

DEPARTMENT OF BLOOD TRANSFUSION SERVICES
Introduction
Blood Transfusion Service, JPMC, is a hospital-based blood bank, which is working with collaboration of Patients’ Aid Foundation, JPMC based non-governmental organization. Blood Bank, JPMC is registered under Sindh Blood Transfusion Act by Sindh Blood Transfusion Authority. AIDS Surveillance Centre is a national voluntary counseling and testing centre for HIV infection.

Data for January 2009 to December 2009
Total donor bled: Average donor a day Total whole blood and packed cell arranged: Total F.F.P. arranged: Total Platelets arranged: Total Cryoprecipitate arranged: Total = 39859 = 109/day =61471 =7290 =1993 =304 =71058

Goals
To promote voluntary blood donations. To promote rational use of blood by providing blood products. To ensure safety of blood and blood products. To provide voluntary counseling and testing facilities for HIV infection. To offer teaching and training facilities at undergraduate, postgraduate and paramedical Levels. To create awareness of blood transmitted infection in the community. To promote research in the field of blood transfusion.

Average arrangement of blood and product a day:=195/day Annual prevalence of HCV infection =1503 (3.8%) Annual prevalence of HBV infection =1324 (3.3%) Annual prevalence of HIV infection =07 (0.02%) Annual prevalence of VDRL infection =213 (0.53%)

Achievements
Successful participation in Quality Assessment Program of National Reference Laboratory, Australia. Publication of scientific papers in the well reputed international and national scientific journals. Active participation in local, provincial, national and international efforts for safe blood transfusion.

Organization and Personnel Administration
Jinnah Postgraduate Medical Centre, Ministry of Health, Government of Pakistan

Collaboration
National AIDS Control Program, National Institute of Health, Islamabad. Patients’ Aid Foundation: a non-governmental organization. Sindh Blood Transfusion Authority.

Quality Assurance
Affiliation with National Reference Laboratory, Australia

Personnel
Assistant Professor/Blood Bank Officer Asstt. Blood Bank Officer Supervisor Technician Nursing Attendants Sanitation staff

Routine Services
Camping for voluntary blood donations Facility based collection of blood for walk in donors. Preparation of blood products. Screening of blood for blood transmitted infections. Provision of safe blood and blood products to the needful patients. Counseling, diagnosis for HIV, AIDS, infections. Teaching, training and research. Antenatal screening for hemolytic disease of newborn.

DEPARTMENT OF CLINICAL ONCOLOGY
FACULTY
The organization flow chart of Department of Clinical Oncology is as follows: Designation Professor of Radiotherapy Associate Professor/In-charge Assistant Professor Administrative RMO Sr. Registrar Status Dr. Prof. Ahmed Usman Vacant Dr. Heeranand Keswani Dr. Tehseen Khurshid Dr. Ghulam Haider Follow-up cases Male Female Patients received Radiation Therapy Patients admitted 34169 15858 18311 568 1806

FACILITIES
The Department of Clinical Oncology is the first oncology centre established in Pakistan. The centre is rendering services to the patients all over the country. It is one of the 25 clinical disciplines of JPMC consist of 48 bedded indoor facility along with day care center and teletherapy services. By the Grace of God a new oncology ward complex has been constructed in the vicinity of Radiotherapy department with an estimated cost of Rs. 50 million which is functioning very effectively. We are providing all oncology services under one roof for the sake of convenience to the patients. Indoor and Outdoor treatment facilities and day care chemotherapy Palliative Care to Cancer Patients Radiation Treatment

One original study on efficacy of Folfox 4 adjuvant treatment in Ca Colon in our local population is in process of completion Another original study on Neo-Adjuvant chemotherapy in Ca. Breast is also in process of publication. Another study on Cancer Registry one the last 10 years has been completed.

ACTIVITIES
The department has established CME programs through which lectures and group discussions in the field are being conducted on monthly basis. The invited speakers also deliver lectures in the said program. Conduction of regular clinical meetings Regular classes for DMRT-I & II trainees Weekly self assessment tests are conducted for DMRT students Weekly case presentations Weekly death meeting to discuss different aspects of management and cause of death in cancer patients

TRAINING
We are running a two years postgraduate training program leading to DMRT, which is affiliated, with Liaquat University of Medical and Health Sciences and recognized by PMDC. At present 09 postgraduate students are enrolled in this program and are completing their training for part-I and part-II. ACHIEVEMENTS DURING THE YEAR 2008 Registered Case 2169 Male 1144 Female 1025

DEPARTMENT OF CLINICAL PATHOLOGY
FACULTY
Dr. Syed Owais Ahmed Assistant Professor of Clinical Pathology Dr. Zahid Ali Abidi Medical Officer Main Laboratory operates in one of the most dynamic tertiary hospital JPMC in Karachi Main. Lab is the only unified service provider in JPMC round the clock throughout the year, able to serve all the patients who come in OPDs and Emergency and admitted in different wards with comprehensive laboratory tests.

LABORATORY TESTS ARE AS FOLLOWS:
Clinical Chemistry Hematology Microbiology Serology Emergency Lab Urine / Stool D/R Anti HCV HBs Ag Hb AIC Grand Total 742811 108083 10758 11826 447707 34359 16804 16804 170 1389322

FACILITY
We are emphasizing laboratory worker training on par. In addition, we are focusing on improving our patients and clinician satisfaction level to bring us in line with the best. Significant effort is also being made in infrastructures improvement, introduction of new operational support system including computer reports and patient care and laboratory test process improvement with the introduction of strict internal & external quality control system. The number of patients coming to JPMC is increasing due to increased growth of population in Pakistan and proportionately the pressure of laboratory tests continues which is now exceeding. 1.3 million test/annum so we are trying to enhance our capabilities from our existing instrumental base. We are having some modern automatic chemistry and hematology analyzer like SELECTRA-XL, Abacus, Medonic, Nihon Koden, Sysmex, Easilyte, Evolis, Unosys/ Automatic (ELISA), etc etc.

ACADEMIC ACTIVITIES, TRAINING & RESEARCH & ACHIEVEMENT
Moreover the department involvement in academic activities continues throughout the year and it provides training, teaching, and research facilities to M.Phil, FCPS students. The department also offers education facilities to the students of College of Medical Technology and teaching/training facilities to paramedics like laboratory technician and medical Technologists & particularly provides teaching & training facilities to 45 students of laboratory training course of Benazir youth program in this current year 2009.

DEPARTMENT OF DERMATOLOGY
FACULTY
Professor & Head: Assistant Professor: Registrar: RMO: Prof. Azam J Samdani Dr. Behram Khan Khoso Dr.Sameera Rizwan Dr. Sobia Dr. Qaisera Dr. Syed Farooq Shah Chromoblastomycosis: In a 10 year old Pakistani boy. 6th SARCD & 7th SODVELONCON (National Conference of Society of Dermatologist, Venereologists and Leprologists of Nepal), 13-15, Nov, Kathmandu, Nepal, 2009. Awareness of Acne and its relationship with Diet and Stress.6th Liquat National Hospital Symosium, Karachi, Pakistan, 11-13, Dec 2009. Cutaneous Leishmaniasis. “Breakthrough in Cutaneous Therapy”. 6th Liquat National Hospital Symosium, Karachi, Pakistan, 11-13, Dec 2009.

INTRODUCTION/BACKGROUND
The Department of Dermatology is a fully established unit with highly qualified faculty members. We are attempting to make it a center of excellence for clinical, academic and research activities in the field of dermatology. It is a 20 bedded tertiary care unit with both outdoor and indoor facilities.

PUBLICATIONS:
Laboratory studies and clinical trials on new formulations against cutaneous Leishmaniasis: Dermatologic Therapy, USA. 2008. (Accepted for publication). “A rare Albino village of Bhatti tribe in Upper Sindh.” An Epidemiological study: Iranian Journal of Dermatology. .(Accepted for publication.).

FACILITIES
Total number of beds-20(male 12 and female 8) Twice a week OPD-Tuesday and Friday Dermato-surgical procedures such as cautery, cryotherapy, electrofulgation once a week Referral management of indoor units of JPMC, NICVD and NICH.

MEETINGS REPRESENTED ACADEMICS
C.M.E for post/under-graduates and paramedical staff. Academic sessions such as journal club and clinical pathological meetings are arranged fortnightly. Lectures & Clinical teaching of final year students of SMC. Teaching and training for Post Graduates Residents in General & Family Medicine from AKU in OPD. Programme Manager’s Meeting on Leishmania Control, WHO/EMRO , Sharm Al Sheikh ,Egypt, Oct 2009. 6th SARCD (South Asia Regional Conference of Dermatology, Venerology and Leprology) & 7th SODVELONCON (National Conference of Society of Dermatologist, Venereologists and Leprologists of Nepal), 13-15, Nov, Kathmandu, Nepal, 2009.

OTHERS ACHIEVEMENTS: RESEARCH
Following projects are in progress A comparison study of two brands of Adapalene gel for the treatment of Acne. A comparison study of Adaplene alone and combination of Adapelene and clindamycin for the treatment of mild to moderate Acne. The association of Pemphigus Vulgaris and Hepatitis B and C virus. The association of Pemphigus Vulgaris with different Blood Groups. Many FCPS-II residents from medicine and ophthalmology have restarted their clinical rotations in dermatology. The department is in the process of being recognized for MD in Dermatology from University of Karachi. Prof. Azam Samdani is co-supervising students doing MS in psychology/sociology and M.Phil in pharmacology from BMSI, JPMC respectively. Reverse teaching has been started by Prof. Azam Samdani on telemedicine to train doctors working in rural areas of Sindh for treating basic dermatology problems.Dermatology is the most active department involved in telemedicine services being provided by JPMC centre.

TRAINING
Post-graduate training for FCPS II candidates (Medicine & Ophthalmology). Diploma course is about to start. Academic activities for house officers are carried on weekly basis.

PRESENTATIONS
Leishmaniasis in Pakistan “Epidemiology & Challenges in the management of Cutaneous Leishmaniasis in Pakistan” Programme Manager’s Meeting on Leishmania Control, WHO/EMRO , Sharm Al Sheikh ,Egypt, Oct 2009. Molecular studies of children with Ichthyosis Vulgaris for the detection of filaggrin gene mutation (R501X) in Pakistani Famalies.6th SARCD & 7th SODVELONCON (National Conference of Society of Dermatologist, Venereologists and Leprologists of Nepal), 13-15, Nov, Kathmandu, Nepal, 2009.

DEPARTMENT OF DENTISTRY & ORAL DISEASES
Faculty:
Dr. Abid Mehmood Incharge

A single dental institute existed in the country for about twelve years after the independence. In 1960, the government decided to install dental surgeons in three main medical institutes. It was also decided to set a Dental Pain Relieving Clinic in JPMC. Dr. Syed Naseem Haider Rizvi (a premier and prominent dental surgeon) was assigned the task, who started the job from a scratch. His tremendous work was soon recognized and from one room clinic, the premises were shifted to the present building where full fledged dental department was established in 1980. At present this department is divided into five sub-sections, namely Diagnosis and Dental Radiology, Exodontia, Operative Dentistry, Periodontology, Oral Surgery and Endodontics. It helps to manage the treatment delivery in a better way. The department is equipped with 20 dental units, 2 intra-oral x-rays machines, 2 OPG machines, 1 digital intra-oral X-rays machine, 1 laser dental unit and 1 photo-dynamic laser machine for the treatment of advanced oral cancer lesions. Including 1500 patients with precancerous and oral cancer lesions, about 30,000 dental patients are treated yearly. Approximately, 40-50 house officers and clinical attaches are being trained yearly in this department. Postgraduate students also attach themselves for internship. The Oral Surgery section possesses special attractions for postgraduates in this field, throughout the country. There are three faculty members, who work tirelessly to provide all types of dental treatment to the needy and ailing humanity. In spite of heavy workload, some time is spared for research purposes also. Dental surgery assistant course is another feature in which 10-20 students are trained every year. It is planned that this department should stand out with colours like JPMC itself, and wished that it should emerge as centre of excellence one day, Insha-Allah.

DEPARTMENT OF ENT (WARD-15)
INDOOR & OUTDOOR STATISTICS

WARD NAME: Sanctioned Bed Strength Activated Bed Strength Admission Discharges Deaths Outdoor Patients No. of OPDs. Operations
Admissions/Day Discharges/Day Mortality Rate (%) Bed Occupancy Rate (%)

E.N.T. WARD-15 40 37 1355 1357 10 54423 247 2165
3.71 3.72 0.73 89.55

Average Patients/OPD

220.34

DEPARTMENT OF GYNAECOLOGY AND OBSTETRICS- UNIT I
FACULTIES:
Professor Associate Professor Assistant Professor Assistant Professor Senior Registrar : : : : : : Prof. Sheeren Z. Bhutta Dr. Razia Korejo Dr. Ayesha Nasir Dr. Haleema Yasmin Dr. Iffat Javed Dr. Shazia Naseeb
4 4 4 4 trainees and Resident Medical Officers, House Officers present details of events of the last 24 hours and all admissions are discussed in detail. Teaching/Training classes for House officers, Postgraduate trainees, undergraduate and student Nurses. Periodic assessment of House officers by written and clinical tests. Training course for postgraduate trainees twice a year. Monthly maternal and perinatal mortality meeting. The following research projects are being conducted presently in the unit: Ongoing Trial of Active Management 3rd stage of labour in collaboration with Prevention of Postpartum Haemorrhage Initiative. The role of partogram to reduce complications in labour Research project “Prevalence & treatment of Methicillin Resistant Staphylococcus aurous in obstetrics and gynaecological sepsis at tertiary care hospital” approved by funding by PMRC. Perinatal mortality rate in relation to fetal gender

FACILITIES IN THE DEPARTMENT:
The department of Obstetrics and Gynaecology consist of Ward-8 (Unit-I) and Ward-9 (Unit-II), the units are on call on every alternate day, each unit has to conduct three operation lists, two gynaecological OPDs and one Antenatal clinic every week. Special gynaecological clinic i.e. infertility clinic, HRT clinic are also conducted twice a week, Hypertension and cardiac clinics are organized on antenatal day in collaboration with NICVD. This department has 135 beds, a separate Casualty department and separate Labour suite.

RESEARCH:
4 4 4 4

Operation Theatre:
There are five operation theatres, two for emergency and three for elective surgery. Apart from conventional gynaecological surgery Endoscopic surgery, operative hysteroscopy, laparoscopic and colposcopic surgical facilities are also available.

INTERNATIONAL RESEARCH PROJECTS:
4 Community based interventions to reduce maternal and perinatal mortality and morbidity in ruler sindh Pakistan awarded by International Federation of Obstetrics and Gynaecology.(FIGO) 4 Project on Obstetric fistula, an obstetric problem, awarded by World Health Organization.

Labour Room:
One labour suite with 10 beds in 1st stage room, 3 fully equipped labour rooms with facilities of Cardiotocography (CTG) ultrasound, Entonox administration, and central oxygen supply function round the clock. The labour and delivery suite also has 5 beds in the immediate postoperative and recovery room which in addition to other facilities has a ventilator as well. Four additional beds are reserved for academic patients requiring intensive care.

ACHIEVEMENTS:
Postgraduate trainees from postgraduate Examinations. 4 FCPS 4 DGO 4 Intermediate Module the unit passed the following 2 3 8

INTERNATIONAL ACHIEVEMENTS:
Prof. Shereen Bhutta received a FIGO award in” women recognition in Obstetrics and Gynaecology. Dr Haleema Yasmin was selected in FIGO 2009. International fellow ship program started from 25th Sep 9th Oct 2009 held in Cape Town South Africa.

STATISTICS (Ward-8, Unit-I):
4 4 4 4 4 4 Total No. patients seen in Casualty Total No. of admission Gynae admissions Obstetrics Admission Abortions OPDs Antenatal Gynaecology 17,710 9, 580 786 8,476 318 31,007 19,866 11,141 7,821 1,450 1,082 368 351 119 2,726 1,886 840 57 40 17 461 199 222 40

NATIONAL AND INTERNATIONAL CONFERENCES:
4 Prof: Shereen Bhutta, Dr Razia Korejo and Dr Haleema Yasmin attended a FIGO XIX World Congress of Gynecology and Obstetrics held at Cape Town South Africa from 5th to 9th Oct 2009. 4 Dr Razia Korejo attended 8th International Scientific Meeting of Royal College of Obstetricians and Gynecologists from 7th to 9th Dec 2009 in Abu Dhabi. 4 Dr Razia Korejo attended a workshop on “Experts in Cancer Education and Leadership Initiative” on 6th Dec, 2009 held in Abu Dhabi. 4 Dr. Ayesha Nasir attended the XX1st AOCOG congress meting from 25th to 30th March 2009 in Auckland New zeland. 4 Dr Ayesha Nasir Attended workshop on reproductive health in Egypt. 4 Dr. Haleema Yasmin attended a workshop of values clarification and attitude transformation from 3rd to 5th Aug, 2009 at Carlton hotel Karachi arranged by Ipas international. 4 Dr Ayesha Nasir conducted a workshop on hysteroscopy held in LUMHS Hyderabad on Oct 25th 2009. 4 Two Workshops on EmOC for medical officers from all over country with the collaboration of PAIMAN were conducted in the Department Obs and Gyn in April and Oct 2009. 4 Two workshops on skills development of EmOC and Ultrasound for health care providers with the collaboration of MOH and UNFPA held at the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Center Oct 13th to 25th Oct 2009.

4 Total No. of deliveries Lower segment Caesarean section 1. Emergency 2. Elective Forceps Vacuum 4 Total No. of operations Major Minor 4 Total No. of maternal deaths Hospital deaths Brought dead 4 Total No. of perinatal deaths Fresh stillbirths Macerated stillbirths Neonatal deaths

POSTGRADUATE TRAINING:
Department is recognized for FCPS, MRCOG, M.S, DGO. 4 FCPS trainees 22 4 DGO 10

PUBLICATION
Sami S, Korejo R, Bhutta S. Prevalence of hepatitis B and C, JPMC experience. J obest Gynaecol Res (AOFOG) 2009; 35(3):533-38.

WARD ACTIVITIES:
4 Daily morning meetings in which all faculty members Postgraduate

DEPARTMENT OF GYNAECOLOGY AND OBSTETRICS - UNIT II
FACULTY:
Professor Assistant Professor Senior Registrar Registrar Prof. Nagina Fatima Dr. Samia Shuja Dr. Khadija Bano Dr. Afia Ansar Dr. Saba Khan Dr. Nasreen Kishwar Dr. Mirab Emanuel Total No. of Operations Obstetrical Hystectomy Major Gynaecological Operation Minor Operation Tubal ligation Vasectomy Total No. of Maternal deaths Total No. of Perinatal deaths Fresh stillbirth Macerated Stillbirth Neonatal deaths 4611 33 1791 1641 1362 60 60 928 494 243 191

INTRODUCTION:
The department of Obstetrics and Gynaecology consists of two wards (8 & 9),a separate emergency room, and a labour suite. The total bed strength of wards is 140 of which ward-9 (Unit-II) has 73. Ward-9 conducts combined antenatal and gynaecological clinics three days a week and side by side care is provided to the seriously ill and laboring patients reporting to the emergency room. In a week, three operation lists for planned surgical procedures are conducted. Regular ward rounds by faculty members are carried out daily.

WARD ACTIVITIES:
Daily morning meeting in which all faculty members, postgraduate trainees, resident medical officers and house officers meet and go through details of the last 24 hours, admissions are discussed in detail and appropriate plans made for their management. Tutorials/classes for house officers, postgraduate trainees, undergraduate students on Tuesdays and Thursdays. Periodic assessment of House officers and Postgraduates is done by written and clinical tests. Death conference is conducted every week. Teaching rounds for postgraduate House officers & undergraduates thrice weekly by Professor and Assistant Professors. Weekly ward round to look for area of improvement in patient care. Regular meeting in ward with donors to encourage them for donation for needy and poor patients.

Facilities in the department:Special Clinics:Special gynaecological clinics i.e. infertility clinic and menopause clinic are conducted twice a week. Hypertension and cardiac clinics are organized in collaboration with NICVD. Diabetic clinic is arranged in collaboration with Diabetologist.

Operation theatre:
There are five operation theatres, two for emergency and three for elective surgery. Apart from conventional gynaecological surgery, Laparoscopy, hysteroscopy and colposcopy is also done. Manual Vacuum aspiration is done in specially allocated post abortion care room.

POSTGRADUATE TRAINING:Postgraduate Doctors working in the department FCPS 19 DGO 04 Trainees passed in the year 2009 Intermediate Module (Passed) DGO

Labour room:
One labour suite with 10 beds in 1st stage room, 3 fully equipped delivery room with facilities of Cardiotocography and ultrasound. Entonox administration and central oxygen supply function round the clock. The labour and delivery suite also has 5 beds in the immediate postoperative and recovery room which in addition to others facilities has a ventilator as well. Four additional beds are reserved for eclamptic patients requiring intensive care.

10 04

RESEARCH WORK COMPLETED IN GYNAE UNIT-II
a. Research Papers Published 1. Spinal vs General Anesthesia in emergency Cesarean sections to see maternal and neonatal effects. 2. Comparison of Oral versus vaginal Misoprostol for induction of labour at term. 3. Is single oral dose of Misoprostol a safe alternative to manual vacuum aspirations for post abortion care? 4. Case report published in JCPSP- November, 2009-rupture of primigravid Uterus. b. Paper under the Process of Publication 1. Laparoscopic findings in chronic pelvic pain. 2. Outcome of teenage pregnancy. 3. Transvaginal repair of VVF (Vesico vaginal fistula) a prospective study.

STATISTICS:
Total No. of Patients seen in Casualty 20034 Total No. of Admission Obstetric Admission Gynaecological Admission Abortion Total No. of patients seen in OPD Out door Obstetric Patients Out door Gynae patients Total No. of Deliveries Vaginal Deliveries C-Section 8459 7300 693 496 44841 27736 17105 6654 5361 1293

c. Research Completed 1. Active versus conventional management of 3rd stage of labour. 2. Role of CTG in detecting foetal distress during labour. 3. To compare the safety and efficacy of manual vacuum aspiration for first trimester abortions. 4. Maternal outcome in mild to moderate mitral stenosis. 5. Effect of age on vaginal birth after C/S. 6. Comparison between maternal and fetal outcome in vaginal and C/S breech deliveries in primigravidas. 7. Incident of endometrosis in cases undergoing laproscopy in primary infertility. 8. Complications of twin pregnancies.

RESEARCH WORK ONGOING IN GYNAE UNIT-II
1. 2. 3. 4. Role of MgSO4 for seizure prophylaxis in pre-eclamptics. Role of B-Lynch suture in PPH. Role of Internal iliac artery ligation in PPH. Advantages of interval hysterectomy in cases of morbidly adherent placenta.

ACHIEVEMENT AND ACADEMIC ACTIVITIES:
Nine doctors completed FCPS Postgraduation Ten doctors passed Intermediate Module Four doctors completed DGO Prof. Nagina Fatima is an examiner of CPSP for FCPS/MCPS & intermediate module exams. Dr. Khadija Bano is a master trainer for MVA in post abortion care in JPMC, working in collaboration with National Committee for maternal and neonatal health in province of Sindh. Dr. Afia Ansar has been facilitator for CPSP preparatory courses for FCPS/MCPS students.

DEPARTMENT OF MEDICINE (WARD-5) & National Poison Control Centre Federal Ministry of Health and WHO
FACULTY:
Prof. Jamal Ara Dr. Liaquat Ali Dr. Rukhsana A. Sattar Dr. Rasheed Durrani Dr. Tahir Ansari Dr. Tariq Aziz Dr. Shaam Kumar : : : : : : : Professor Professor Associate Professor Senior Registrar Senior Registrar Senior Registrar Registrar Diagnosis, Evaluation and management of all types of poisoning 24 hours on call. Provide Online services to public and private sector regarding poison control and its first aid management Library having Internet facility and largest collection of books on chemical poisoning provided by Ministry of Health & WHO Training programs for doctors and nurses Public Awareness programs. Teaching Clinical Toxicology, at National Poison Control Center, Medical Unit I, Jinnah Post Graduate Medical Centre, Karachi. Teaching Pharmacology, School of Physiotherapy, Jinnah Post Graduate Medical Centre, Karachi from 1999 till date Teaching Toxicology, 3rd Year MBBS, Ziauddin Medical University, Karachi as visiting Professor Teaching Clinical Toxicology, Final Year MBBS, Sindh Medical College, Karachi. Lectures & Facilitation of Seminars for D. Pharmacy and M. Pharmacy students, University of Karachi. Supervises Weekly Clinical Case Presentation, at National Poison Control Center, Karachi. Clinical round of NPCC along with bedside teaching to medical students, post-graduates, and residents on daily basis. Teaching FCPS Part II postgraduates in Clinical Toxicology at NPCC, JPMC, Karachi Trained 100 doctors of Basic Health Units, Government of Sindh on “Pesticide poisoning management” at Hyderabad on 11th May 2003 sponsored by Crop Life Pakistan Regular Serial Workshops on Evaluation, Diagnosis, & Management of Poisoning, National Poison Control Center, Jinnah Post Graduate Medical Centre, Karachi. Workshops on Poison Control & Chemical Safety in different cities, under the auspices of Ministry of Health & WHO. Holds local and country wide workshops on Poison control and management round the year. It provides complete registry of patients, information given to the medical personel and public about the poison control and chemical safety, gives treatment to the poisoned patients, and above all this center also involved in research and academic activities for the betterment of patients.

INTRODUCTION/BACKGROUND
Medical Unit-I (Ward-5) has a 55 bedded medical unit, with National Poison Control Center of Federal Ministry of Health and WHO with 10 ICU beds and 4 step down beds. The ward is a recognized unit for postgraduate training by College of Physicians and Surgeons of Pakistan, Royal College of Medicine of United Kingdom and University of Karachi. This unit has elective students from all the leading tertiary medical schools (both the private and pubic) and from International Medical Universities like China and UK. It is providing special care to the admitted patients as well as running general OPD and specialist OPDs. This unit is one of the most sorted with maximum admission per year and maximum numbers of out patient attendance. This unit is one of the most organized and busiest at Jinnah Postgraduate Medical Center, Karachi.

Vision And Mission.
To provide better evidence based medical care to the patients. Structured training and research facilities to the undergraduate and postgraduate medical students. Management, research and prevention of poisoning cases.

Facilities: January To December 2009 Incharge
General Medical OPD (i) male (ii) female Twice a week Prof. Jamal Ara OPD attendance 49433 Admission in the Ward 4450 Average Patients/OPD 49932 Prof Jamal Ara This unit is providing the toxicological emergency cover for all types of poisoning including snakebite. The patients from all over Pakistan are referred to this department as no other hospital in public sector, in the province has poison control unit to deal with poisoning emergencies. To deal these types of emergencies, the NPCC has modern equipment and enough trained staff including doctors and nurses. The cases admitted have unsually been poison by chemicals and drugs, animal bite, plants, heavy metals etc. The center is providing evaluation (record data), diagnosis, investigation and management of poisoning cases. The service provided is round the clock and 365 day a year. Actual Bed Strength = 10 Occupancy Strength = >10

National Poison Control Center Incharge and National Coordinator

RESEARCH/PRESENTATION:
1) 2) 3) 4) 5) 6) 7) 8) 9) 10) Vitamin B12 deficiency still the common cause of megaloblastic anemia. Iron deficiency anemia in women of child bearing age. Cost of diabetic care in community. Malarial Hepatopathy. Hyperglycemic emergencies and their precipitating in Department of Medicine. Dietary services available for diabetic patients and patients satisfaction at JPMC, Karachi. Electrocardiographic changes in patients with Acute Stroke. Association of NAFLD with dyslipidemia and obesity. Effect of statin on lipid profile of hypothyroid patients. Prevalence and fatality related to methanol poisoning.

Number of Patients admitted in NPCC per year
2005 1075 2006 1424 2007 1158 2008 1257 2009 1217

ACTIVITIES (2009):
4 Daily ward rounds by Incharge of Ward and Associate Professors.
Daily 1 hour teaching class for House officer Postgraduate after rounds 1. Clinical Class of postgraduate. a) Case presentation b) Problem case discussion. c) Clinical methods. 2. Death conference fortnightly. 3. General Club fortnightly. 4. Clinical Class of undergraduate of SMC daily by RMO, Senior Registrar, Associate Professor. 5. Morning presentation every week in Department of Medicine (Ward – 7) by postgraduate students. 6. Morning presentation in ward every Friday morning of new admitted patient. 7. Final year lectures in Sindh Medical College by consultants of wards. Ward activities include OPD two times per week. Ward activities also include emergency duties 10 times per month. (24 hour duties in Accident & Emergency Department) 30 Postgraduate Students are undergoing training leading to F. C. P. S–II. We got undergraduate students of III, IV and Final Year M. B. B. S. from Sindh Medical College for clinical teaching and training. Their classes a taken regularly and the progress of each group is assessed at the end of their posting and duly recorded in their progress books

Poisoning cases admitted in NPCC
Alcohol intoxication Corrosives Dhatura Poisoning Drug Overdose and abuse Heroin Capsule as body packers Insect bite Kerosene Oil ingestion Opium poisoning Pesticide Rat Killer ingestion Snakebite Unknown Poisoning

4 4 4 4

Functions of NPCC:
Deals with all kinds of poisoning emergencies coming through A & E department, JPMC.

Workshops
Workshop on Electrocardiography. Workshop of Clinical Toxicology

TRAINING:
Department is actively involved in training of future consultants. -FCPS -MCPS -Clinical Toxicology

ACHIEVEMENTS:
Passed Intermediate Module. 1. Dr. Sarwar Malik 2. Dr. Iqbal 3. Dr. Dania 4. Dr. Maseer 5. Dr. S. Hisallah Rehman 6. Dr. Nasrullah 7. Dr. Dleep Kumar 8. Dr. Erum Passed fellowship examination from College of Physicians and Surgeon Pakistan. 1. Dr. Shobha 2. Dr. Asif Usmani Dr. Tariq Aziz and Dr. Tahir Ansari got training in Endoscopy.

FUTURE PLAN:
Up gradation of National Poison Control Centre Up gradation of existing Medical Unit. Establishment of Gastro and Colonic endoscope research cell Up gradation of Research cell. Establishment of Poison Information Services Establishment of Provincial poison Control Centres all over Pakistan.

DEPARTMENT OF MEDICINE (WARD-6)
FACULTY :
Prof. Tasnim Ahsan Dr. Tariq Mahmood Dr. Niaz Ahmed Dr. Ali Shaheer Dr. Muhammad Umar Farooq Dr. Zeenat Bano Dr. Subheen Kanwal Dr. Rakhshanda Jabeen Dr. Fayyaz Mujtaba Head of the Department Associate Professor Assistant Professor Senior Registrar Senior Registrar Senior Registrar Senior Registrar Senior Registrar Deputed to NICVD

ULTRASOUND FACILITIES:
For all indoor patients ultrasound facility is available within the department.

ANNUAL BUDGET:
Allocated budget for the year 2008 was Rs.14,80,000/-( Fourteen lacs Eighty Thousand Only) for indoor patients. Specialty clinics expenditures were met by Medicine & Endocrine Foundation.

ACADEMIC ACTIVITIES: CONSTRUCTION:
We have a plan of developing “ Skills Laboratory” on the first floor of existing ward. The project details have already been sent to the Ministry of Health , Islamabad. Teaching ward rounds are conducted twice weekly each by Professor, Associate Professor , Assistant Professor and Senior Registrars. As a part of the regular teaching programme multimedia presentations are done weekly on recent articles published in various journals . Topic oriented lectures are delivered both by PGs and interns weekly. Case presentations on admitted patients with interesting findings are also done twice weekly.

MEDICAL FACILITIES:
Patients with diverse medical problems are admitted and provided comprehensive medical care. During the past year 2530 patients were admitted and treated. Mortality was (27.08%).

POSTGRADUATE STUDENTS: ICU FACILITIES:
3 bedded ICU started functioning in June 2004. Total of 256 patients were admitted in need of critical care during 2009. 10 patients received ventilatory care. At present 14 postgraduate students are undergoing training for FCPS/MRCP. Two postgraduate students, i.e. Dr. Rakhshanda Jabeen and Dr. Nisar Ahmed have passed FCPS II exam in 2009. House officers average 20-30 doctors in each 6 month tenure of house job. They are graduates of different medical colleges of the country apart from the regular lot of SMC graduates.

MEDICAL OPD:
General Medical OPD is conducted twice weekly on Tuesdays and Fridays. Around 20-25 cases are admitted on each emergency/admission day from OPD and emergency department. Patient attendance in every medical OPD is around 369 patients / OPD. Total 36168 patients visited the medical OPD last year. Besides medical OPD 3 specialized clinics are also run by the department.

OTHER ACADEMIC ACTIVITIES:
Monthly Endocrine meetings are held in rotation with AKUH, LNH, Baqai Hospital & NICH. Leading Endocrinologists of the city participate and interesting cases are presented and discussed in these meetings alongwith an exhaustive review of one endocrine topic.

ENDOCRINE CLINIC:
Patients with endocrine problems are seen twice weekly. This clinic was established in 1993 and is supervised by Professor Tasnim Ahsan. 7654 patients with various endocrine diseases have been registered so far. 2533 patients were seen in 2009. Out of which 1097 were new cases.

RESEARCH:
The unit is currently engaged in research on various aspects of Metabolic Syndrome. A study on “Liver disease in Metabolic Syndrome” has been started as the first recipient of “ Sarwar Zuberi Research grant of PMRC ”. The rest of our projects of drug interventions are awaiting funds from the Ministry of Health, Islamabad.

RHEUMATOLOGY CLINIC:
Dr. Tariq Mahmood, Associate Professor of this unit supervises the Rheumatology Clinic that is conducted once weekly. 552 new cases were seen this year. Total registered patients in this clinic are 1387.

PUBLICATIONS:
A case report on “ Chronic Arsenic Poisoning” was published in JPMA in February, 2009.

DIABETIC CLINIC:
Diabetic clinic started functioning in September, 2004, supervised by all faculty members in rotation. This clinic is held twice weekly. A total of 1815 patients have been registered uptil now. 939 patients visited OPD this year.

DEPARTMENT OF MEDICINE (WARD-7)
FACULTY:
Dr. Syed Muhammad Munir Dr. Syed Masroor Ahmad Dr. Kirpal Das Dr. Amanullah Dr. Zeeshan Ali Dr. Shabnam Dr. Tharpal Das Dr. Shafique Rehman Dr. Rabia Ghafar Dr. Munir Afzal Dr. Ghafrana Memon Professor of Medicine Senior Registrar Senior Registrar Senior Registrar Senior Registrar Senior Registrar Medical Officer Medical Officer Medical Officer Medical Officer Medical Officer ESR Widal test ASOT CRP (C-Reactive Protein) RETIC APTT HCV T4 LH PRO 2350 19 03 05 -3644 4032 343 360 370 R.A.. Test VDRL HBA1C MP PT AFB T3 TSH FSH URINE PT 13 02 07 845 3794 662 340 380 365 12

INTRODUCTION/BACKGROUND
Medical Unit-III (Ward-7) is a 51 beds unit, which is a recognized unit for postgraduate training by College of Physicians and Surgeons of Pakistan and University of Karachi. It is providing in care facility to the admitted patients as well as running general OPD and specialist OPD for Diabetics and Gastroenterology patients. This unit is equipped with modern research oriented Laboratory, Diabetic Clinic and G.I. Clinic for indoor as well as outdoor patients the in the premises. Under able guidance of Prof. S.M. Munir this unit is one of the most organized units in Medical Department of J.P.M.C.

We have high-tech. Elisa Machine and plate reader on which we can performed all sorts of markers, profiles and specialized tests including hormone assays.

4. Hepatology Clinic (Prime Minister Program)
This Unit is the Sentinel Site Prime Minister program for Prevention and control of Hepatitis since 2005 and has been recognized as a esteemed and reputed centre for treatment of patients of Ch. HepatitisC and Ch. Hepatitis-B. 1033 patients have been registered and treated successfully. This is an going program and new patients are being registered.

5. Pakistan Bait-ul-Mal.
Pakistan Bait-ul-Mal provides treatment of Ch. Hepatitis B- & Ch. Hepatitis C patient and 208 patients have been registered for treatment of above disease.

OBJECTIVES:
To provide the best medical care to indoor and outdoor patients. Training of undergraduate and postgraduate students. Research and publication.

ACTIVITIES:
Teaching of undergraduate medical students of Sindh Medical College, Karachi. Teaching/training of postgraduate medical students for MCPS, FCPS and M.D. Daily morning meeting for clinical presentation by medical and allied units. Topic oriented symposia. CME programs are organized in Medical Unit-III, JPMC. Three examinations of MBBS final year held from January 2009 to September 2009.

FACILITIES:
1. In-door Patients Total Admission Discharge Death General OPD Diabetic Clinic (5 days a week) G.I. Clinic (Once a week) Gastroscopies Colonoscopies 2223 1824 399 Twice a week (Wednesday & Saturday) 15621 7424 1166 123

TRAINING:
Department is actively involved in training of future consultants. Following postgraduates are attached with the unit: -FCPS-II 24 Candidates

2. Endoscopy
We are doing both diagnostic and therapeutic endoscopies e.g. Band ligations, Sclerotherapies, Stricture dilatations, Oesophageal stent placements, Hemostatic clips, P.E.G. Tube insertions, Polypectomies. Stone extraction etc.

Research
Five papers are published in International Journal. 1. Frequency Of Anti Hcv Antibody In Type 2 Diabetic Patients In Pakistani Population. Jama Pakistan Vol.20 No.1-2 March – April 2009. 2. Clinical Feature Diagnostic Technique For Combined Infection Of Malaria & Dengue Jcpsp 2009. 3. Hypokalemic Paralysis And Megaloblastic Anaemia In Laurence moon-bardet-biedl Syndrome – 2009.

3. Laboratory
The laboratory of Ward-7, J.P.M.C. is doing all routine tests besides it has made any new additions. The statistics of routine tests are as follows: Routine Biochemistry tests 134400 - HbsAg 4032 Electrolytes 9433 - Urine D.R 644 Sputum D.R 662 - CP. 10530

4. Association Of Hepatitis C-virus With Diabetes Mellitus – 2009. 5. Thrombocytopenia In Malaria In Cpsp Journal 2009.

ACHIEVEMENTS:
The laboratory of Ward-7 is now accredited by International Quality Assessment Scheme from Central Laboratory, London. 2 candidates have passed their fellowship examination from College of Physicians and Surgeons of Pakistan: (Dr.. Susheel, Dr. Aziz Saitho in 2009 ) 2 Candidates have passed MRCP in 2009. Dr. Shabnam - Dr. Mohan

FUTURE PLAN:
We are planning to upgrade our diabetic clinic by setting an Institute of Diabetology and Metabolic Disorders. In addition to dealing with diabetic emergency and providing routine care of diabetic patients, it will act as a focal point of research in diabetes, not only imparting training to future consultants of JPMC but also establishing a 24 hours hot line, so that any doctor or patient in the country can contact. Upgradation of G.I. Clinic and establishment of ERCP facilities.

DEPARTMENT OF MEDICAL ICU
FACULTY:
Dr. M. Azhar Chaudhry Dr. Aly Haider Dr. Qurban Hussain Shaikh Dr. Shahbaz Haider Dr. Noor Muhammad Solangi Dr. Nanak Ram Associate Professor/Incharge Associate Professor Senior Registrar Senior Registrar Senior Medical Officer RMO

RESEARCH
Research study ‘Single dose of octreotide reduces the portal pressure as assessed by Doppler ultrasound. ’ (Under print in JCPSP) Research study ‘Carvedilol reduces the portal pressure assessed by damping index waveform in portal vein’. (Under print in JCPSP)

ACHIEVEMENTS
Dr. M. Kaleem Part-II trainee of this ward passed intermediate module of FCPS.

INTRODUCTION:
The goal of intensive care is to save lives of patients with acute life threatening but reversible medical conditions through aggressive therapy, interventions, close monitoring and use of Electromechanical devices. In order to achieve this goal, the Medical ICU at JPMC comprises 18 Beds. Out of this 5 beds are in Critically Ill Patient Area (CIPA) and 13 beds in the step down care. Over period of time the unit has acquired an experience in dealing with complications of end stage liver disease. Other than that patients of septicemia, respiratory failure, encephalitis, cerebral malaria and dengue fever were admitted and managed. Many of the ill affording patients were given free medicines through zakat funds and philanthropic donations. The unit also runs a once weekly follow up clinic for the patients who were treated in the ward and discharged. To cater to the increasing number of follow up patients the follow up clinic has been shifted to OPD No 6 in the main Surgical Building.

Future Plan
Ground breaking ceremony of new building of Medical ICU was held in July 2009 at place of old Radiotherapy OPD. It is our desire and ambition to create a state-of-art training facility for the future ‘Intensivists’ with the help of Patients Aid Foundation (PAF).

FACILITIES:
The Medical ICU is equipped with facilities for bedside monitoring, infusion pumps for accuracy of drug delivery, defibrillators, piped oxygen delivery, ventilator, and portal x-ray machine.

STATISTICS:
(Jan – Dec 2009) Admissions Deaths Follow up OPD Patients 1204 320 2554

ACADEMIC ACTIVITIES:Weekly Morning meeting of clinical presentation for Medical and allied units. Daily Morning and afternoon academic meetings. Daily teaching rounds and bedside clinical methods class.

DEPARTMENT OF MICROBIOLOGY, BMSI
FACULTY
Professor of Microbiology Assistant Professor Dr. Saleem Ahmed. Kharal Dr. Mohammad Asif Durrani The Department is working as reference laboratory. Moreover, culture sensitivity tests of different specimens (580), AFB (155), mycological specimens (56) and parasitological specimens sent to the Department from different wards and OPDs have been routinely carried out and reported in time. A new method Nitrate Reductase Assay (NRA) has been introduced for drug susceptibility testing of Mycobacterium tuberculosis. Moreover this department is engaged in nosocomial surveillance to make the Hospital pathogen free. Department is also providing facility for water testing. In this regard water samples (200) from different areas Karachi and JPMC have been tested and reported. The results however turned out to be eye openers to ponder over.

Department of Microbiology like the previous years continues to provide education, training and research facilities to M.Phil and Ph.D. students in Microbiology and moreover to those students who opt to take Microbiology as a minor subject. It also provides a forum for presentation of research papers and thesis. In the Department, ELISA equipments, Fluorescence microscope, High Performance Liquid Chromatography (HPLC), Teaching Microscope, different types of incubators including CO2 incubator, Cool incubator, which can be adjusted at different temperatures, refrigerators, centrifuge machines (Ordinary and Refrigerated), water baths (shaking and ordinary), pH meter, water distillation plants, deionizer, compound microscopes, sterilizers, Safety Cabinet Class II, staining and culture facilities for bacteria, fungi, parasites and Mycobacteria are available. Dr. Ahmed Ali Khan has appeared in final M.Phil Examination in December 2008. His research topic was:Identification of mycobacterium species by non-conventional method and its comparison with conventional methods along with the sensitivity pattern in clinical practice (Dr. Ahmed Ali Khan) Dr. Shafqat Qamar, Dr. Hadi Imam, Dr. Sambreen Rafique and Dr. Samia Khanam have completed their major and minor subjects successfully. Their synopsises have been approved from University of Karachi and they are carrying out their research. Their topics of research were: 1. Resistance pattern of extended spectrum beta lactamase producing enterobacteriaceae isolates from surgical wards (Dr. Shafqat Qamar) 2. Bacterial gastroenteritis impact in drinking water of Karachi and drug resistance of the isolated organisms (Dr. Hadi Imam) 3. Efficacy of salmonella typhi vaccine prepared from local strain at BMSI, JPMC, Karachi (Dr. Sambrin Rafique). 4. Identification of (XDR) extremely drug resistant pattern in multidrug resistant TB isolates (Dr. Samia Khanam). One more student has completed his course work and is preparing his synopsis for onward transmission to University of Karachi. A batch of 3 more students has completed their major as well as their first minor subject. A new batch of four students has started their course from September, 2008.

NEONATOLOGY UNIT/OBST/GYNAE JPMC
Neonatology Unit plays a key role, works round-the clock, rendering services to Unit – I and Unit-II of Obstetrics and Gynaecology. There are about more then 16,000 deliveries per annum. This unit is looking after all the babies, in collaboration with NICH and is firmly committed to train paramedics, house officers and postgraduates to cognize the common and basic problems of newborn, in ward, labour room and operation theatre. The department also conducts combined morning meeting, indoor postnatal round in each shift and also holds workshop on neonatal resuscitation every three months and teaches the lactation management skills.

FACILITY:
Incubator Heated cot Central oxygen supply Stand by generator Apnae monitor Pulse oximeter Resuscitation trolley

STATISTICS YEAR OF 2009
Total admissions Reference to NICH Neonatal deaths including transfer to NICH 2172 340 202

Indication for admission in Nursery:
Meconium aspiration and birth asphyxia Low birth weight plus IRDS Sepsis Neonatal jaundice Infant of diabetic mother Birth injuries Metabolic disorders Haemorrhage diseases of newborn 812 718 168 93 108 30 20 35

Congenital anomalies:
Meningomyelocele Hydrocephalus In born error of metabolism Duodenal atresia + Tracheo-esophageal fistula Congenital heart disease Anencephaly Imperforate anus Ompholocele 51 28 15 12 52 17 07 06

DEPARTMENT OF NEPHROLOGY (WARD-22)
FACULTIES:
Associate Professor Dr. Manohar Lal Dawani (Incharge Unit) Dr. Abdul Manan Junejo Dr. Darshan Lal Dr. Dileep Kumar Dr. Nausheen Iqbal Dr. Maseer Ahmad Daily evening round with one senior consultant, Postgraduates & house physicians on duty. Every Wednesday lectures by Postgraduate on various topics. Every Friday Journal Club with Postgraduates on latest articles. Every Saturday topic combined Nephro-Urology presentations conducted by Postgraduate trainees. Dr. Manohar Lal. Arranged course for Postgraduates. One paper was published in JCPSP. Attended 7th Biennial Nephrology Conference at Faisalabad one papers & One poster presentation. Annual Symposium JPMC, one paper. Screening of normal renal functions in population of Gazdarabad (Ranchhor line-karachi), District Mirpur Khas & Umerkot in association with The Kidney Foundation, Karachi. Medical Camps at Tando Muhammad Khan & Mir-pur Khas, in addition workshop on Kidney diseases at Mir Pur Khas, for doctors. Medical Camp & Lecture on “Vascular Access” at Kidney Centre, Quetta. Arranged the “World Kidney Day” with Kidney Foundation & also participated in screening of women prisoners at central jail Karachi. Participated in radio & TV talks on awareness of kidney diseases. Dr. Abdul Manan Junejo. Attended “World Congress of Nephrology” 2009 at Milan, Italy. Organizes Postgraduate course for students of Nephrology and other specialties. Arrange and actively participate in World Kidney Day at JPMC, Karachi. Lecture on Prevention of CKD in Symposium of Pakistan Society of Nephrology at JPMC, Karachi. Delivered lecture on HTN CKD at PIA Karachi. Participated in Radio talk on epidemic of CKD on event of World Kidney Day. Attended 7th Biennial Nephrology Conference at Faisalabad.

Assistant Professor Registrar/Medical Officers

FACILITIES:
We provide in patient facility of 38 beds (20 beds in ward & 18 beds in Dialysis) with emergency cover 24 hours/day & seven days a week. OPDs are conducted thrice weekly on Monday, Tuesday & Thursday. Patients seen in OPD 4836 Patients Registered in OPD 1210 Admission (Jan 2009 to Dec 2009) 3657 Almost all types of Hematological, biochemical, immunological tests are carried out of outdoor & indoor patients free of cost. Chest & KUB/Bone x – rays of patients are carried out. Facility of tissue typing for renal transplant is also available.

Dialysis Facilities.
The Department has got facility for dialysis i.e. haemodialysis and peritoneal dialysis. Well established dialysis unit that comprises of 17 dialysis machines including dedicated machine for Hepatitis B. The dialysis Unit runs round the clock for emergency dialysis and maintenance haemodialysis. 42 patients are registered for twice a week maintenance dialysis. No of Dialysis done: New Patients inducted 310 Haemodialysis 4358 Peritoneal dialysis 010 Double lumen catheter 0372 Undergraduate (Sindh Medical College) & Postgraduate teaching. House physician training.

RESEARCH PROJECTS.
A) COMPLETED Etiology & outcome of ARF in Pregnancy(published in JCPSP) Pattern of dyslipedemia in CRF. Frequency of Hepatorenal Syndrome in Hepatitis - C Patients Pattern of ARF in JPMC Frequency of malnutrition inflammation complex syndrome in patients on maintenance H.D. Pattern of Renal Osteodystrophy in patients on maintenance H.D. Echocardiographic findings in Haemodialysis patients. Skin Manifestation of CKD patients. Frequency of UTI in pregnant females. Screening of relatives of patients with CKD. B) On Going: Thyroid problem in CKD. Estimation of GFR in Healthy population.

ACHIEVEMENTS:
During last year following equipment & consumables were added: Dialysis machines 01(received through donation) Computerization of the patient’s record (in progress). Establishment a library containing books, journals & CDs on Kidney Diseases, New Books & Journals added.

ACTIVITIES
Daily ward round for indoor patients at 9am. Every Wednesday and Saturday grand round with all seniors and house physicians, RMO and Postgraduates. Prof. S. A. Jaffer Naqvi joins us in the round & presentation every Saturday & Wednesday. Daily round in haemodialysis unit.

COURSE/WORKSHOP.
Arranged 2 days symposium on 5th & 6th December, 2009 on “Early Detection & Prevention Of CKD” for postgraduates. In this symposium, Director of USRDS Prof. Allan J.Collins & various Nephrologists from Karachi delivered lectures on common renal problems and shared their experience with Postgraduates.

TRAINEES:
Six Postgraduate trainees have completed their training in FCPS Nephrology. Eight are being trained for FCPS in Nephrology Postgraduates for FCPS – II in medicine on rotation from various medical units for the completion of their requirement.

FUTURE PROJECTS:
Establishment of ICU. Acquiring of Original books & Journals for Library

REQUIREMENT:
Appointment of 32 posts according to PC-I (1996) Construction of Offices

DEPARTMENT OF NEUROLOGY
Faculties
Professor Assistant Professor Senior Registrar’s One One Two

INTRODUCTION / BACKROUND
Neurology unit at JPMC is the oldest and one of the only four such units in the country. It provides neurology services to approx 40 millions population (provinces of Sindh and Balochistan)

Facilities
Out Patients Department 26,360 patients attended OPD held on every Monday Thursday Besides Monday and Thursday Daily OPD including Special OPDs, for Parkinson’s disease Dementia Epilepsy, Multiple Sclerosis. Daily Consultant OPD where difficult and referred patients are discussed with consultants for case & comfort of patients that have been referred from an out of Karachi emergency.

Objective / Targets
As a part of public sector and an important institute the primary objective is to provide quality and dedicated health care services to the community. And to train professionals belonging to faculty of neurology who can server the nation with pride.

Organization / Personnel
The faculty of the department includes an Emeritus Professor, an Associate Professor and Incharge of the department, an Assistant Professor and senior Registrars. The medical staff also includes a trainee registrar, Postgraduate for FCPS Neurology, Postgraduate student for MD Neurology and Postgraduate Students for Diploma in Clinical neurology (DCN). Paramedical staff includes nurses, nursing attendant, EEG technologists, a peon, a gardener and a sanitary worker.

Emergency
24 hours daily services are provided to patients referred to neurology department.

Indoor
1522 patients are admitted in neurology department from January 2009 to December 2009.

Routine Services provided
The department has an OPD wing, an investigation wing a 31-bedded ward and an academic floor. It conducts 3 times weekly OPD (300 patients per OPD), daily emergency and referral cover and inpatient services. It is equipped with modern medical equipments including X-ray, EEG, EMG. The academic floor has a library and three computers with Internet facility. The clinical services have an OPD load of 200 new patients per year and 25,000 old patients per year. The special clinical include those of epilepsy, migraine, movement disorder including Parkinson’s disease, Wilson’s disease, myasthenia and dementia. This department is actively involved in academic activities including training for diploma in Clinical neurology (10 students), FCPS Neurology (1student), MD Neurology (6 students) and allied fields. The undergraduate training imparted to the students of Sindh medical College. The paramedical training includes those for School of Physiotherapy, School/College of Nursing and EEG technologist. This department has a vast experience in neurology research including epilepsy, migraine, movement disorders (including Parkinson’s disease, Wilson’s disease), Myasthenia and dementia. The research papers have been presented and published at national and international forums.

Diagnostic Facilities
Diagnostic facilities including EEG, EMG, NCV are provided to patients.

Activities
Teaching of undergraduate medical students of Sindh Medical College Karachi Teaching/Training of Post Graduate students of Diploma in Clinical Neurology (DCN) FCPS (Neurology), MD (Neurology). Teaching/Training of Post Graduate Students of General Medicine for their clinical rotation in Neurology from JPMC, other hospitals of Karachi and also out of Karachi where Facility of training in Neurology is not available. The Para medical training Include these for school of Physiotherapy, School College of Nursing & EEG Technologist. Awareness program was held for patients of Parkinson’s disease and Multiple Sclerosis last year.

Research
The department has vast experience in Neurology research including Migraines Movement of Disorder (Parkinson’s disease, Wilson disease) Myasthenia Gravies and Dementia. The research paper have been presented and published in natural and international.

Training
The department is actively involved in academic Activities Including for Post Graduates in FCPS (Neurology) 10 candidates DCN 10 Students, MD (Neurology) candidates. FCPS (General Medicine) on their clinical rotation of neurology (10), The Para medical training includes these for school of Physiotherapy, School College of Nursing & EEG Technologist.

CONSTRAINTS
Only meager resources Financial Resources both for inpatients and outpatients Technical Resources

INDOOR & OUTDOOR STATISTICS
January 2009 to December 2009 Bed Strength Admissions Discharges Deaths Outdoor patients No. Of OPDs 31 1522 1441 93 26,360 101

ACHIEVEMENTS
Research work done under following: Epilepsy Multiple Sclerosis Parkinsonism Alzheimer’s disease & other dementias Neurological Infectious diseases Young Stroke

DEPARTMENT OF NEUROSURGERY (WARD-16 & 18)
FACULTY
Dr. A. Sattar M. Hashim Professor & Head Dr. Lal Rehman Assistant Professor Dr. Arshad Ali Assistant Professor (Sharing with Neuro-radiology Department)

FACILITIES
All diagnostic facilities of neuron-imaging including CT, MRI, C-arm, EEG, Angiography, Microscopic. Operative – General neurosurgery – Stereotactic neurosurgery, spinal reconstruction and trauma surgery O. V. Jooma Memorial Course of Neurosurgery at International level date Participated in National & International Conference / courses Participate in inter departmental monthly meetings

TRAINING
Postgraduates leading to FCPS Postgraduates leading to M. Sc ( UK ) six six

PAPERS
1. Professor A. Sattar M. Hashim Papers on congenital anomalies published in Journal of Surgery (Sarc) 2. Dr. Lal Rehman Papers under publication

INDOOR & OUTDOOR STATISTICS JANUARY 2009 TO DECEMBER 2009
Ward-16 Brain Cases 2360 1811 350 52 9053 100 1461 75 64 6.47 4.96 14.30 110.82 170.53 Ward-18 Spinal Cases 508 494 29 Nil 9203 47 210 0 25 1.39 1.35 5.54 105.50 195.81

Admissions Discharges Deaths Lama Outdoor Patients No. of OPDs Operation Sanctioned Bed Strength Activated Bed Strength Admissions/Day Discharges/Day Mortality Rate (%) Bed Occupancy Rate (%) Average Patients/OPD

DEPARTMENT OF ORTHOPAEDIC SURGERY (WARD-14 & 17)
PROFESSOR:
Prof: Ghulam Mehboob Prof. Anisuddin Bhatti (Ward – 14) (Ward – 17)

SENIOR REGISTRARS / MEDICAL OFFICER:
Dr. Azad Ali Sheikh

REGISTRARS ASSOCIATE PROFESSOR:
Dr. A.R. Jamali Dr. Nasir Baig Dr. Saeed Ahmed Dr. M. Qasim Dr. Kashif Mehmood Dr. Barkatullah Dr. Muhammad Suleman

ASSISTANT PROFESSOR:
Dr. M. Saeed Minhas Dr. Irfanullah Ansari Incharge Physical Medicine & Rehabilitation.

ADMISSION:
Total admitted cases were Total Discharge Total Death Operations Performed Out Patient Department No. of OPD’s W-14 1137 1099 16 1168 35113 150 + + + + + + W-17 879 = 869 = 11 = 1096 = 25457 = 100 = Total 2016 1968 27 2264 60570 250

I. INTRODUCTION / BACK GROUND:
Department of Orthopaedic Surgery was established in 1955. It comprises two wards each with capacity of 40 beds. The unit is headed by a Professor. There are 05 out patient clinic weekly and 08 operation suites under anesthesia and 02 suites weekly under local anesthesia along with round the clock emergency service. The Orthopaedic Surgery department deals with patient coming from 1/3rd of the Karachi and upcountry including far flung areas of N.W.F.P. Punjab, Balochistan and Sindh. The department has produced 48 FCPS and M.S. consultants, working all over the country. Department has published, 52 research publications printed in PMDC recognized national and international journals.

IMPORTANT PROJECTS:
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Total Knee Replacement. Total Hip Replacement. Spine Surgery (Scoliosis). Congenital Dislocation of Hip. Congenital Knee Dislocation and AMC. Ponseti Technique to TEV Management. Fibular Grafting for Femoral Neck Fracture. Limb Sparing Tumor Surgery. Ilizrove Surgery. tsp superposed DHS

II. OBJECTIVE / TARGETS:
To under take patients care, teaching undergraduates (M.B.B.S., Physiotherapy, Nursing, Paramedics, Medical Technologists) and Postgraduate FCPS, M.S Orthopaedic, FRCS and other disciplines of surgery, conducting research and publication, CME activities like lectures, courses and workshops.

III. ANNUAL BUDGET:
Annual Budget of Orthopaedic ward is Rs. 02 million, which come to about Rs: 70/= per patient per day. However the implants are being purchased by patients themselves or provided by Zakat Department and some by Philanthropists.

VI-B ACHIEVEMENTS AND ACADEMIC ACTIVITIES:
A) J.P.M.C. Orthopaedic department arranges an intensive clinical course for FCPS candidates, of one week duration. This is attended by more than 30 candidates from all over the country. The salient features of the course are mock examination including short, long cases, viva and OSCE, along with interactive vibrant discussions among the examiners and the candidates; we do not charge any course fee. B) Pakistan Orthopaedic Association South chapter meeting held twice in our department, attended by large number of Orthopaedic Surgeons and postgraduates, where difficult and challenging cases were discussed.

IV.A) ORGANIZATION:
The department of Orthopaedic Surgery is an 80 (eighty) bedded unit with round the clock emergency and daily Orthopaedic and fracture OPD.

C) Weekly Orthopaedic conference was regularly convened on every Friday for two hours, supervised by Prof: Emeritus Z.K. Kazi, Prof: Suleman A. Khan, Prof: Idrees and attended by all the faculty of Orthopaedics of JPMC and postgraduate residents. D) 16 Postgraduate are under training for FCPS and 04 for M.S. Successfully Passed Candidates 1. 2. 3. 4. 5. Dr. Khurram Rasheed Dr. Nasir Baig Dr. Adeel Dr. Toufeeq Dr. Salman Adil MRCS FCPS II FCPS II FCPS II MS (Orthopaedic Surgery)

Post fellowship training scholarships are non existent and this is need of time to keep one self aware of latest developments and technology advancements.

E) Publication in year 2009: Outcome of Single versus two incision operative approach used for one stage correction of neglected congenital dislocation of the hip joints. By Dr. Anisuddin Bhatti. JPOA Vol. 21 No. 2 August 2009 Broken Bones and Bone Setters. By Dr. Anisuddin Bhatti. Medical Channel January 2010 medical channel: No.16CD/ 7–9 Pakistan: The New Target of Terrorism. The Karachi’s Emergency medical response adequately prepared. JPMA vol. 59, No. 7 July 2009 441-445

VII) INVITED TALK:
Workshop on Reconstruction Surgery for Cerebral Palsy & Rehabilitation (Dr. Anisuddin Bhatti) Workshop on “Bomb Blast Injuries Pattern and Disaster management at LMR Peshawar (Dr. Saeed Minhas). Two day Primary Trauma Care Course at JPMC for 25 participants. Orthopaedic Review Course for FCPS Orthopaedic Part – II

VIII CONSTRAINT:
The work load on the department has tremendously increased due to blowing population of Karachi and increasing No. of accidents. However the teaching posts in this 80 bedded remain the same since inception of Orthopaedic Surgery ward in 1959 - 76 i.e. one Professor, two Associate Professors and two Assistant Professor, which results in too much constraint to deal significantly increasing patient load. There is need to increase number of operating suits, especially we are in dire need of separate, properly equipped and staffed operation theater. The budget of department is not in accordance with work load. The instruments need to be replaced or procured new one to keep pace with new developments in the department.

DEPARTMENT OF PATHOLOGY, BMSI
FACULTY:Incharge/ Associate Professor Assistant Professor. Dr. Shahnaz Imdad Kehar. 1. Dr. Naushaba Rahat. 2. Dr. Naila Tariq. 3. Dr. Muhammad Anwar. 1. Dr. Humera Shahzad. 2. Dr. Ayesha.

ACHIEVEMENTS:1. Total number of histopathological specimens were 5620 and number of Cytology specimens were 3960 received and diagnosed with the credibility for satisfaction of clinicians. 2. Efforts are being made for availability of antibodies for immunohistochemistry and immunoflurosence microscopy. 3. 13 Postgraduate students are presently enrolled for M.Phil training programme in the department.

Lecturer:

FACILITIES:The pathology department is providing free of cost facilities Histopathology and Cytopathology for the admitted patients of JPMC. FNAC of out door patients as well as admitted patients and histopathology of samples received from other Hospitals done with proposed charges.

ACTIVITIES:
a) Actively providing diagnostic facilities like histopathology and cytopathology on regular basis. b) FNAC clinic thrice a week. c) Immuno chemistry of selected cases with available antibodies. d) Training of M.Phil post graduate students in Pathology. e) Weekly journal club and slide seminars participated training and education by students and pathologists.

TRAINING:
Training and education of M.Phil students as well as FCPS postgraduate students for rotation posting according to standard teaching programme.

RESEARCH:The following two research projects completed during academic year. 1. Morphological study, P53, BCL2 expression in breast carcinoma. (Dr. Fouzia Shaikh). 2. Frequancy of carcinoma cervix, cyclin A2 and P53 in dysplasia and carcinoma in cervix.(Dr. Rubab Naqvi).

ON GOING RESEARCH PROJECTS:
Research work is in process for three proposed studies tittled as:1. Use of Immunoflourrence technique to confirm the diagnosis of lupus dermatitis and lichen planus with emphasis on over lap syndrome and its origin. 2. Diagnosis of hydatiform mole using p57 immuno histochemistry. 3. Diagnostic assessment of problematic prostates specimen using cyto keratin 5 – 6

DEPARTMENT OF PHARMACOLOGY & THERAPEUTIC, BMSI
A. FACULTY:
Professor & Head Department of Pharmacology and Therapeutics Assistant Professor Dr. Muhammad Umer Balouch 1) Dr.Ayesha Siddiqui Topic: To evaluate the effectiveness of Metformin in diagnosed Polycystic ovary syndrome 2) Dr. Ali Gul Topic: Study to compare efficacy and adverse effect of Trazodone and Paroxetine in the treatment of major depressive disorder. 3) Dr. Syed Muhammad Masood Ali Topic: Study to evaluate The effectiveness of clindamycin gel versus fusidic acid cream topical therapy in diagnosed venereal vulgaris in local population. 4) Dr. Dial Das Topic: Study to Compare the efficacy of topical lodoxamide with sodium cromoglycate for the treatment of diagnosed verenal keratoconjuctivitis.

Dr. Moosa Khan

B. ACTIVITIES: Main Activities:
a. Enrolled students of every new batch, have to go through orientation classes initially, then are assessed, after about every 6-weekstime, through periodicals. The new batch of five students, have completed their first two periodicals. The four students of new IInd year are engaged in their research work, their project proposals have been approved by BASR, University of Karachi in September 2009. Four students of senior most batches will appear in final examination in February 2010. The Course, Practical Work, is assessed (as periodicals) and routine Research Works in the Department are in progress. The few articles that have been published in the recent Journals of International repute were first presented in the Seminars. The freshly published articles are presented in the Journal Club weekly, by one student in turn. The old protocols/practical have been changed on new trends (on line) For this purpose the old instrument/equipments have been changed to new ones. The various collaborative Research Works which are regularly conducted with different Departments/ Wards/ Clinics/ OPDs are effectively in progress. Problem solving discussions are also organized on weekly basis.

b. c.

D. TRAINING:
Trainings Post-Graduate Teaching in Basic and Clinical work at the level of M.Phil degrees/courses are conducted on regular basis.

d. e. f. g. h.

E. ACHIEVEMENTS:
All M.Phil research projects/ studies, duly approved by the BASR, University of Karachi for Batches 2006-07and 2007-08have been completed successfully.

i.

j.

New Batch2009-2010:
The following 5-students have completed their two periodicals, and are ready to appear in the IIIrd periodical, named: 1. Dr. Irfan Zafar 2. Dr. Fara Asad 3. Dr Fatima Rizvi 4. Dr. Syeda Zain 5. Dr.Rana Mehmood

C. RESEARCH: Senior Most Batch:
The four students of the senior most batch cleared their final seminar and appeared in final examination to be held in the month of February, 2010.

Intermediate Batch:
All the students of new 2nd year have completed their major subject and one minor subject as well. After the search of articles they started writing their protocols/synopsis which have been completed approved by the BASR University of Karachi and the research is in progress under the supervision of Dr. Moosa KhanThe Research topic of the individuals are:

DEPARTMENT OF PLASTIC & RECONSTRUCTIVE SURGERY
FACULTY
DR.NASIR ZAMAN KHAN DR.NISAR AHMED MANGI DR.MOHIBULLAH KHAN ASSOCIATE PROFESSOR ASSISTANT PROFESSOR SENIOR REGISTRAR

FACILITIES:ONE G.A. THEATRE. ONE L.A.THEATRE TWO WOUND DRESSING ROOM ONE LIBRARY CUM-SEMINAR ROOM

ACTIVITIES:Monday – Tuesday Wednesday Thursday Friday Saturday OPD from 9.00 am to 1:00pm Ward Round with Postgraduate Teaching + Local Theatre (LA) G.A.Theatre and Local Theatre. G.A.Theatre and Local Theatre. Ward Round and Journal Club (Postgraduate Training) G.A.Theatre and L.A Theatre.

TRAINING
Four M.S. Student training in Plastic Surgery and 2 FCPS(General Surgery) trainees on rotation.

RESEARCH:Synchronous repair of Bilateral Cleft Lip & Nasal deformity by Mulliken’s Technique. Bilateral Cleft Lip nasal deformity by Salyer’s technique.

ACHIEVEMENT:Two postgraduate are appearing in exam in March, 2010. WARD NAME Sanctioned Bed Strength Activated Bed Strength Admissions Discharges Discharges/Day Deaths Bed Occupancy Rate (%) Out-Door Patients Average Patients/OPD No. of OPD”s Operations PLASTIC SURGERY WARD-24. 40 34 281 283 0.78 02 96.85 2443 12.21 48 885

DEPARTMENT OF PHYSICAL MEDICINE & REHABILITATION
FACULTY
Dr. Irfanullah Ansari Dr. Zamir Hussain Baloch Ot. Humaira Masood Pt. Shahwar Mustafa Pt. Bashir Ahmed Qureshi Mr. M.A. Hafeez Head Of The Department/Principal, Medical Officer Incharge Incharge, Physiotherapy O.P.D. Clinical Incharge, Students & House Officers. Supervisor, Orthopaedic Workshop

TEACHING AND TRAINING:
F.C.P.S. in Physical Medicine & Rehabilitation. Postgraduate Training to the F.C.P.S. Part-II candidates, posted in Physical Medicine & Rehabilitation from Orthopedic Surgery. B.Sc. in Occupational Therapy. Clinical Training of B.Sc. Occupational Therapy students in department of Occupational Therapy. Clinical Orientation visits from various Organization / Hospitals / Nursing Institutes.

FACILITIES:
Management of rehabilitation to patients having impairments and disabilities College of Occupational Therapy for 03-Years B.Sc. Occupational Therapy Degree Program. Physiotherapy O.P.D. Occupational Therapy O.P.D. 4 C.P 4 M.R. 4 Delayed Milestone 4 C.V.A. 4 R.A, O.A. 4 Speech Patients 4 Erb’s Palsy 4 Spina Bifida 4 Psychiatric Patients (Child & Adult) 4 etc. Rheumatoid Arthritis O.P.D. EMG and Nerve Conduction Testing. Polio Conference Orthotics and Prosthetic Workshop

FUTURE PLAN
To extend 03 years B.Sc. Occupational Therapy to 04 years B.S. Occupational Therapy Program. To enhance the Research program at Department of Physical Medicine & Rehab. To improve treatment facilities at Physical Medicine O.P.D., Physiotherapy O.P.D., Occupational Therapy O.P.D. and Orthopeadic Workshop.

NUMBER OF PATIENTS ATTENDED O.P.D. IN 2009
Physical Medicine & Rehabilitation Physiotherapy O.P.D. Occupational Therapy O.P.D. 2545 25019 7711

STRENGTH OF STUDENTS:
College of Occupational Therapy 46

ORTHOSES AND PROSTHESIS DELIVERED TO THE PATIENTS DURING THE PERIOD:
S.NO 01. 02. 03. 04. 05. 06. 07. 08. 09. 10. 11. 12. 13. 14. 15. NAME OF OBJECTS A.K Prostheses P .T.B. Prostheses Upper Limbs Long Leg Brace Short Leg Brace Spinal/Tailor Brace Surgical Shoes Hand/Other Splint Arch Support Heel Pad A.F.O. Lumbo Corset Leather Jacket KAFO Repair Orthosis TOTAL QUANTITY 18 38 08 75 04 10 60 40 125 35 417 04 16 05 36 891

ACTIVITIES:
Lectures of Postgraduates, Occupational Therapy Patient Management Evaluation, Lectures of Students of B.Sc. Occupational Therapy. Rehabilitation of Physically and Mentally disabled patients.

RESEARCH:
Role of Physical Therapy in patients who present with Backache. Role of Rehabilitation in Neuromuscular Diseases. Functional outcome of Rehabilitation Management in Stroke patients. Role of Occupational Therapy in management of Cerebral Palsy. Polio Myelitis. Role of Occupational Therapy in speech patients.

ACHIEVEMENTS:
Yearly basis admission in College of Occupational Therapy has been started on merit basis. The College of Occupational Therapy successfully completed affiliation process for B.Sc. Occupational Therapy with the University of Karachi. The classes were conducted very regularly and examination system was regularized and now January to December Session is in progress. The course curriculum was successfully completed in time by all the respective teachers by the end of academic session.

DEPARTMENT OF PHYSIOLOGY, BMSI
FACULTY:
Assistant Professor/Incharge: Medical Technologist Physiological Technician Laboratory Assistant Dr. Abdul Shakoor Memon Mr. Ghulam Mustafa Abro Mr. Mehboob ur Rehman Mr. Abdul Saeed

FACILITIES:
The department provides regular course Physiology leading to M.Phil/PhD in addition to understanding the research skills and preparation of synopsis and thesis. The department is equipped adequately with 21st century, state of the art equipment to cater to the needs of postgraduate students.

ACTIVITIES:
1. Lectures 2. Physiology experiment (Practical work) 3. Seminars and journal clubs 4. Research work

RESEAERCH:
Four M.Phil students will appear in July 2010 final M.Phil examination. Their topics of research are as follows: 1. Thyroid Hormone levels in apparently healthy individuals and type II diabetes mellitus individuals in local population. (DR. ABDUL WAHAB SHAIKH) 2. QT, RR, QTc intervals in apparently healthy individuals of normal Body Mass Index and in obese subjects. (DR. SALEEM ABBAS) 3. Status of appetite hormone Ghrelin in apparently healthy individuals and in lean, obese and type II diabetics. (DR. MONA RANI) 4. The comparative study of pulse pressure, echocardiography and lipid profile in apparently healthy early age menopause and Normal age menopause women in local population. (DR.UZMA TASNEEM)

TRAINEES:
Fourteen M.Phil students have physiology as their major subject, out of which four will appear in June/July 2010 examination. Four more will appear after one year and remaining six will appear in the subsequent year.

PHYSIOLOGY AS MINOR SUBJECT:
Eight M.Phil students from various departments (Biochemistry and Pharmacology) of BMSI have selected physiology as minor subject.

ACHIEVEMENTS:
Four M.Phil students have been declared successfull by the University of Karachi on 5th December 2009.

DEPARTMENT OF PSYCHIATRY
FACULTY & STAFF
Dr. Muhammad Iqbal Afridi Dr. S. Zafar Haider Ms. Salma Lari Dr. Chuni Lal Dr. Zar Wali Professor & Head Assistant Professor Social Welfare Officer RMO RMO

RESEARCH ACTIVITIES
Research/Publications: ‘Psychiatric morbidity among married male and female children & adolescents.’ Presented in 46th Annual Medical Symposium, Jinnah Postgraduate Medical Centre, Karachi, Pakistan. “Physical co-morbidity according to ICD-10 among patients with depressive disorder” Psychiatric Conference, on Spectrum of Mood Disorder to be held from 15th August 2009 at Islamabad. “Body Mass Index of Outpatients with Diagnostic Entity According to ICD-10” Presented in 18th National Psychiatric Conference held in Bhuban, 11-13 December, 2009, published in Abstract Book page 03. Gastrointestinal Somatization in males and females with depressive disorder has been published in internationally recognized indexed Journal (J Pak Med Assoc 2009ÊOct; 59(10):675-9). Dr. Zafar Haider presented paper on social determinants in case of schizophrenic patients at JPMC Annual symposium. Conducted a work shop on positive and negative syndrome scale on schizophrenics at Sir Cowasjee institute of behavioral sciences at Hyderabad. One paper published in Journal of Pakistan Psychiatric Society on role of "John Worts" in Depression. Following research topics are under process in supervision of Prof. M. Iqbal Afridi Assessment of sexual dysfunction in female psychiatric patients using anti depressants reporting at JPMC. Deliberate self harm and the socio demographic factors contributing to it. Insomnia in medical students of public sector medical college Karachi. Suicidal intents and determinants to act on, in depressed patients presenting at JPMC- OPD Motivational factors to quit drug addiction. Frequency of substance use in bipolar affective disorder. A research on “Depression in patients with chronic renal failure on maintenance haemodialysis was conducted and showed that 73% of haemodialysis patients were suffering from depressive disorder

FACILITIES:
Outpatient Department About 29249 patients were seen in twice weekly (Tuesday, Friday) major OPD days. 16478 patients were male and 12771were female. Special Clinics Consultation Liaison Psychiatry (Psychosomatic Disorders) including patient with chronic gastro intestinal symptoms. In all 288 reported at this clinic during last year. 1. Weekly special Clinics for chronic psychotic patients with provision of normal and long acting anti psychotic drugs 2. Weekly Clinic for Government Servants and their dependants every Wednesday 3. Weekly Clinic for drug dependents about 505 patients attended the clinic. 4. Follow up clinic for previously hospitalized Psychiatric patients held on Thursday. 5. Liaison services for medical, surgical & allied disciplines of JPMC, 6. 24 hours emergency coverage at Accident & Emergency Department Others Disposal of forensic/ML cases and administrative referrals from Civil Surgeon for assessment Medicines from Zakat fund provided to needy patients.

In-door services
About 686 patients were admitted in psychiatry department during the year 2009. 465 patients were male and 221 patients were female.

ACTIVITIES
Regular case conference in Psychiatry ward on all admissions Weekly administrative meeting every Wednesday, regular in its fifth year Conducted Examinations of FCPS at CPSP and B.Sc occupational therapy and Physiotherapy of University of Karachi 9 PGS (FCPS) working under supervision of Prof. M. Iqbal Afridi to fulfill part - II training. Lectures of behavioral sciences given by consultants to students of Sindh Medical College. Lectures given to students of occupational therapy. Special Classes and lectures for students of clinical Psychology from various institutes. Classes, weekly journal club, case presentations and topic presentations conducted under supervision of consultants as a part of CME.

ACHIEVEMENT
Prof Dr. M Iqbal Afridi continued as Coordinator Medical Faculty JPMC and Secretary, Faculty of Psychiatry, CPSP (College of Physicians & Surgeons, Pakistan) Conducted examination of undergraduates & postgraduates students JPMC, CPSP, University of Karachi, Agha Khan and Hamdard University. Participated as Assessor & Editor of research papers PJMS, JCPSP & JLUMS as Member Editor, of Editorial Board, JPMA, & JPMRC. As a member of Panel of Experts in PMRC and Higher Education Commission Islamabad, assessed various research projects to justify funding. Reviewed a Textbook on “Integrating Behavioral Sciences in Health Care” a project of Higher Education Commission. Participated in National and International forum. To promote mental health participated on local Radio Pakistan, FM, Voice of America & TV, BBC. Courses attended Facilitated/Resource person “First FCPS training course in psychiatry” at College of Physicians and Surgeons Pakistan Regional Centre “Depression and Anxiety in Primary Care” by American Psychiatric Association, Middle East, North America, Dubai Recovering the whole person in Schizophrenia & bipolar Disorder, Beirut, Lebanon

TRAINING
Undergraduate training of students of SMC, Karachi Postgraduate training leading to MCPS, FCPS and PhD in psychiatry and FCPS-Medicine on rotation B.Sc physiotherapy and occupational therapy Undergraduate and postgraduate nursing Teaching and training to students of Islamic Mission Hospital, Holy Family Hospital, Karachi Adventist Hospital, St. John Homeopathic Medical College, Karachi and Sir Syed Medical College Karachi.

DEPARTMENT OF RADIOLOGY
FACULTY:
4 Professor & Head 4 Assistant Professors : : Dr. Tariq Mahmood Dr. Saima Imran Dr. Arshad Ali Dr. Muhammad Salman Dr. Nadira Abid Dr. Amber Paras Dr. Rajnee Bai Dr. Sohail Ahmed Khaan Dr. Najamul Hasan Dr. Tahera Fatima Zaidi Dr. Fayyaz Ahmad Dr. Razia Tabassum Dr. Rana Yasmin Dr. Syeda Sadaf Rizvi Dr. Tehmina Shah Dr. Kausar Abbas Dr. Shaista Nizam Dr. Rubina Ishtiaq Dr. Mahreen Rasool Dr. Kavita Sattivan Dr. Aneeta G. Muhammad Dr. Rani Bai Dr. Rani Benish Dr. Kausar Ilahi Bux Dr. Asha Kumari Dr. Arifuzaman Dr. Zafar Nasir 08 Dry Laser Imager 1.5 Tesla Phillips MRI, system. Toshiba Flat Panel Whole Body Angiography. Five Computed Radiography systems.

DIFFERENT SECTIONS / FACILITIES:
Accident and emergency section: open 24 hours 365 days a year. Main radiology section: (8.00am to 2.30pm) daily except holidays. C.T Scan section: Daily 24 hours 365 days a year. M.R.I section: (8.00am to 2.30pm) daily except holidays. Ultrasound and Color Doppler: (8.00 to 2.30pm) daily except holidays. Filter Clinic x-ray and ultrasound: (8.00 to 2.30pm) daily except holidays. Echocardiography: (9.00am to 5.00pm) daily except holidays. Invasive Procedures: (9.0am to 2.30pm) daily except holidays. F.N.A.C clinic with Pathology Department: (Saturday 9.0am to12.00pm). Ultrasound facility at Gynae OPD: 9.0am to 1.00pm daily except holidays.

4 Consultant Radiologists :

4 Medical Officers

:

TRAINING:
The department is recognized for F.C.P.S. Diagnostic Radiology Training there are two supervisor and 24 trainees. There is a daily morning session of reporting and discussion followed by hands on procedures. Clinico-radiological meetings are also arranged with different specialties at JPMC. F.C.P.S-II residents of different specialties are also given attachment for elective training for 15 days to six months throughout the year. We also conduct six months basic ultrasound training course twice a year, which include preparation for ARDMS. We have a well-established Library containing a good collection of Radiological Books and Journals. We also have our own Video & CD Library, which helps our doctors under training with new procedures and latest interventions going on around the world. We also have digital data storage and transfer facilities. Radiology Aid Foundation [RAF} is an NGO registered with DSW and FBR it has been working for the benefit of patients since 2000. RAF has been providing a number of equipments, stationary, consumables and staff to operate and report. Out of three lac thirty thousand patient seen during the last fiscal year, one hundred and eighty thousand patients were entertained with the help of Radiology Aid Foundation.

4 Postgraduate FCPS-II :

INTRODUCTION:
4 Radiology is one of the busiest departments of JPMC, established on 15th August 1947. Entertain around 700 to 1100 patients every day. Our Ultrasound/Color Doppler section is the largest in Asia and entertain approximately 500 patients every day. The Department is equipped with: 18 Conventional x-ray machines 02 Fluoroscopy machines 02 C-arms 18 Ultrasound units 04 Power Color Doppler’s. 02 16-Slices Spiral C.T. Scanners 02 Echocardiography Machines. Digital Data Storage and Internal facilities. 08 Auto-processors of 20 to 60l.

DEPARTMENT OF GENERAL SURGERY (WARD-2)
FACULTY:
4 4 4 4 4 4 Professor Ghulam Asghar Channa Dr. Muhammad Shamim Qureshi Dr. Salim Ahmed Soomro Dr. Muhammad Naseem Baloch Dr. Dileep Kumar Dr. Zaka-ur-Rab Siddiqui Professor Assistant Professor Assistant Professor Senior Registrar Senior Registrar Senior Registrar Four postgraduates have passed FCPS-II Six postgraduates have passed IMM examination Three postgraduates have passed MRCS 1&2

RESEARCH CONDUCTED:Role of NG tube in patient undergoing Ileostomy reversal Audit of Splenectomy done in 05 years-elective and emergency cases Audit of surgery for complex fistula in ano in last 5 years Therapeutic role of gastrograffin in the patients with sub acute intestinal obstruction Rationale of near-total Thyroidectomy in MNG patients Contribution of FNAC in the Diagnosis of Malignant Thyroid Nodule Surgical management of Hyper parathyroidism Timing of completion Thyroidectomy and its complications Changing faces of Breast Cancer Treatment Outcome of haemorrhoidal band ligation at JPMC Re-Laparotomy on demand in peritonitis published in Journal of Pakistan Society of Surgeon Laparoscopic assisted colectomy our early experience Case report of duplication cyst in Journal of Pakistan Society of Surgeons GTN ointment healing or headache ?? JPMA Short term out come of stapled Haemorrhoidectomy in Haemorrhoids published in JPMA Outcome of Ileostomy closure at JPMC

INTRODUCTION/BACKGROUND:Surgical Unit-I (Ward-2) is a 40 bedded unit, which is a recognised unit for postgraduate training by College of Physicians & Surgeons, Pakistan, Royal College of Surgeons of United Kingdom and University of Karachi. The unit has its own Endoscopic suite in which upper and lower G.I. Endoscopy are done routinely. The ward is planning to start ERCP in the coming year. The unit is well equipped with all the modern equipments and regularly doing advance open and laparoscopic procedures including single incision laparoscopic surgery (SILS), Laparoscopic Hernia repair, rt. Hemicolectomy, Splenectomy and anterior resection.

AIMS AND OBJECTIVES:Our aim is to deliver quality surgical care to less privileged patients and provide structured surgical training and research facilities to postgraduates and undergraduate students. Our target is to emerge as a centre of excellence.

STATISTICS OF ACTIVITIES DURING YEAR 2009:Total Admission Discharges Deaths Outdoor patients Number of OPDs Operations Bed Strength Admission/day Discharges/day Mortality rate Bed Occupancy rate Average patients/OPD 2059 2026 48 15040 97 1012 46 5.64 2.56 2.31% 69.1% 155.05

ACTIVITIES AND ACHIEVEMENTS:Four Sub-speciality Clinics are run by Specialists BREAST CLINIC THYROID CLINIC COLORECTAL CLINIC HEPATOBILIARY CLINIC GENERAL OPD By Dr. Salim Ahmed Soomro By Dr. M. Naseem Baloch By Dr. M. Shamim Qureshi By Dr. Dileep Kumar By Dr. Zaka-ur-Rab

Ca breast and Oncological advancement an update held in June, 2009 Conducted colorectal week in November, 2009 with Professor Neil Mortenson as a Master Trainer. Conducting Annual examinations of MBBS every year Conducted TDACS for candidates appearing in FCPS/MRCS examination.

DEPARTMENT OF GENERAL SURGERY (WARD-3)
FACULTY:
Prof. Anis subhan Dr. Shahid Rasul Dr. Mazhar Iqbal Dr. Iram Bokhari Dr. Zahid Mehmood Dr. Nasir Ali MBBS, FCPS Professor MBBS, FICS, FCPS, FRCS (Glasg) Assistant Professor MBBS, FCPS Senior Registrar MBBS, FCPS Senior Registrar MBBS, MACS, MCPS, MRCS (ED), FCPS Senior Registrar MBBS, MCPS, FCPS Senior Registrar Date of Establishment: Registered patients: Operations: Research: Research: 1)Performed Sentinel Lymph Node Biopsy (10 cases). 2) An article on Unusual Cases Presented Breast Clinic (submitted to JCPSP). 3) Pattern of Breast Diseases presented to Breast Clinic (submitted for publication). 4) Accessory breast tissues in axilla Management (submitted for publication). 5) Comparison of incision and drainage vs. aspiration in breast abscess (submitted for publication) 6) Early complication of mastectomy with axillary clearance (under process)

REGISTRARS:
Dr. Tanveer Ahmed Dr. S. Shafqatullah Dr. Mahvish Nazir Dr. Asadullah Aslam Dr. Mansoor Iqbal MBBS MBBS MBBS MBBS MBBS

Hepatobiliary Clinic:
January 2003 675 345 1) Role of preemptive analgesia in laparoscopic cholecystectomy (published in JSP). 2) Outcome of surgical management of Obstructive Jaundice (submitted for publication). 3) Role of C-reactive protein in acute pancreatitis (under process). 4) Application of Ranson criteria in acute pancreatitis (under process). 5) Application of APACHE criteria in acute pancreatitis (under process).

INTRODUCTION/BACKGROUND
Surgical Unit-I (Ward-3) is a 40 beds unit, which is a recognized unit for postgraduate training by College of Physicians and Surgeons of Pakistan, Royal College of Surgeons of United Kingdom and University of Karachi. It is providing in care facility to the admitted patients as well as running general OPD and specialist OPDs. This unit is equipped with modern research oriented Upper and Lower G.I. Endoscopes, Laparoscope, Harmonic Scalpel and Sonotom for indoor as well as outdoor patients in the premises. This unit is one of the most organized unit in J.P.M.C.

Colorectal Clinic:
Date of Establishment: Registered patients: Operations: Research: January 2003 892 282 1) Early complications of fistulectomy vs. fistulotomy (submitted for publication). 2) C-reactive protein in Acute Appendicitis (Accepted for publication).

OBJECTIVES:
To provide better evidence based surgical care to the patients and structured training and research facilities to the undergraduate and postgraduate medical students.

FACILITIES:
January to December 2009 General Surgical OPD OPD attendance Admission in the Ward Operation Twice a week 16341 1468 753

ACHIEVEMENTS:
Dr. Shahid Rasul, Assistant Professor; Attended workshop on gastrointestinal laparoscopic surgery Vietduc Hanoi Vietnam in march 2009. Attended meeting of BSS (British Society of Surgeons) Glasgow (UK) in May 2009. Attended IASGO (International Association of Surgeons Gastroenterologists & Oncologists) meeting in china in Oct 2009. Attended meeting on surgical site infections Singapore in December 2009. Dr. Zahid Mehmood, Senior Registrar; Wrote a book on Exam oriented surgical BCQs. Wrote a book on “Exam oriented surgical skill” (2nd edition). Dr. Iram Bokhari, Senior Registrar; She wrote a book a book on selfassesment of surgical skills for students in surgery. Added to the list of reviewer of JCPSP. Conducted Workshop on medical ethics and research methodology in CPSP. Dr. Nasir Ali, Senior Registrar, passed FCPS (general surgery) in June 2009. Dr. Sadiqa, Posrgraduate, passed FCPS (general surgery) in June 2009.

Hernia Clinic:
Date of Establishment: Registered patients: Operations: January 2003 1422 262

Endocrine Clinic:
Date of Establishment: Registered patients: Operations: Research: January 2003 1183 144 1) 10 years Study of Carcinoma thyroid (submitted for publication)

Breast Clinic:
Date of Establishment: Registered patients: Operations: January 1999 944 076

Will start first time in Pakistan Bariatric Surgery soon for this purpose Dr. Shahid Rasul, Assistant Professor got training in the field of Bariatric Surgery. Department is actively involved in training of future consultants, at present 19 postgraduate students are under training and 8 postgraduates are appearing in FCPS-II examination. Dr. Imran Adeeb passed MRCS (viva). The following postgraduate students have passed their MRCS II (Theory) examination: 1) Dr. Maham Yousuf 2) Dr. Quratul Ain 3) Dr. Adeel Hussain 4) Dr. Mehmooda 5) Dr. Surrendar 6) Dr. Asadullah Aslam 7) Dr. Mehwish 8) Dr. Zahid Ali 9) Dr. Ali The following postgraduate students have passed MRCS-I examination in 2009. 1) Dr. M. Sikandar Baig 2) Dr. M. Ali Raffat 3) Dr. Mehvish Nazir 4) Dr. Surrender 5) Dr. Uzair 6) Dr. Navaid 7) Dr. Bashir The following House Officers have passed FCPS-I examination: 1) Dr.Rabiya 2) Dr. Javeria 3) Dr. Batool 4) Dr. Ashar 5) Dr. Sanjay 6) Dr. Ameen 7) Dr. Arsala

13) Role of C-reactive protein in acute pancreatitis (under process). 14) Application of Ranson criteria in acute pancreatitis (under process). 15) Application of APACHE criteria in acute pancreatitis (under process). 16) Causes of acute pancreatitis (under process). 17) Tubercular Fistula in Ano (published in JSP). 18) Early complications of fistulectomy vs. fistulotomy (submitted for publication). 19) C-reactive protein in Acute Appendicitis (submitted for publication).

ACTIVITIES (2009):
Dr. Anis Subhan, Dr. shahid rasul, Dr. Zahid, & Dr. Nasir started SILS in Ward 03 JPMC. Teaching of undergraduate medical students of Sindh Medical College, Karachi. Teaching/training of postgraduate medical students for MCPS, FCPS and MRCS. Daily morning meeting for clinical case presentation by surgical and allied units. Topic oriented symposia on weekly basis. CME programs. Monthly joint meeting with Liaquat National Hospital and Aga Khan University Hospital. Monthly morbidity / mortality meeting. One examination of MBBS final year held from January to December 2009. 12 Research papers presented in 46th annual symposium Jinnah post graduate medical centre, Karachi, Pakistan. Two days workshop on Hands-on Laparoscopic surgery. One day Surgical Skills workshops. Communication skills workshop. Workshop on Communication Skills. Workshop on Total Nutritional Therapy. Workshop Hands on Gastrointestinal Stapling devices. Workshop Hands on Laparoscopic Surgical skills. Workshop on Micro-education technique. Workshop Hands on Basic and Advance Laparoscopic Surgical skills.

RESEARCH PAPERS:
1) Role of Sentinel Lymph Node Biopsy in Breast Cancer (published in JSP). 2) Role of preemptive analgesia in laparoscopic cholecystectomy(published in JSP). 3) Millighan morgan v/s stapled haemorhoidectomy (published in JSP) 4) Role of antibiotics in clean surgery (submitted for publication). 5) Comparison between oral vs. injectable antibiotics in clean surgery (under process). 6) Prevalence of Malignancy in Solitary Thyroid Nodule (submitted for publication). 7) 10 years study of Carcinoma thyroid (submitted for publication). 8) An article on Unusual Cases Presented Breast Clinic (submitted to publication). 9) Pattern of Breast Diseases – presented to Breast Clinic (submitted for publication). 10) Accessory breast tissues in axilla – Management (submitted for publication). 11) Comparison of incision and drainage vs. aspiration in breast abscess (submitted for publication) 12) Early complication of mastectomy with axillary clearance (under process) 13) Outcome of surgical management of Obstructive Jaundice (submitted for publication).

TRAINING:
Department is actively involved in training of future consultants. -FCPS -MCPS -MRCS -FRCS

FUTURE PLAN:
Upgradation of endo-surgery clinic. Laparoscopic advanced surgery. Establishment of ; Hands on Surgical skills workshop centre. Hands on Laparoscopic surgical skills workshop. Bariatric Surgery Centre. Establishment of surgical sub-specialty units at JPMC. Upgradation of Research cell.

DEPARTMENT OF GENERAL SURGERY (WARD-26)
Introduction / Back Ground
Surgical Unit-III (Ward-26) was established in 1991 in order to share surgical training teaching and sharing surgical work load within the department of surgery. Following postgraduate students passed in intermediate module / FCPS examination in 2009. Dr. Muhammad Akhtar Rao Dr. Barkatullah Burki Dr. Taimur Asif Dr. Rekha Kumari.

Objective / Targets
Our aim is to provide best possible surgical care to patient and establish academic set up for under and postgraduate students in such a way that it may become a surgical unit par excellence.

Constraints
Limited no. of postgraduate, house officers. Limited budgetary allocation as compare to other surgical units. Radiological and scanning facilities. Laboratory facilities are limited. There is no secretarial back up cover for the logistics of the ward & record keeping. Limited research facilities available.

Facilities
Following is the working schedule for the ward. Emergency on Wednesday, Saturday and every third Sunday. Out patient department of Wednesday and Saturday. Grand ward rounds on Tuesday and Friday. Round the clock we have senior surgical cover. Laparoscopic and open surgical operation are done twice weekly on Monday and Thursday. Daily morning meeting except O.T days. Ward rounds by incharge of ward and senior registrar daily. Grand teaching round by incharge of the ward on ward days, Tuesday and Friday. Night round by registrar daily. We have dry lab for laparoscopic techniques in ward. Following doctors are under training program in ward. Postgraduate students for FCPS-II Post fellow training attachment FCPS-II House Officers (09) (Nil) (05)

Future Plans
Our future plans are to up-date the ward in a way which designates it as a unit of surgical excellence.

Indoor & Outdoor Statistics January 2009 to December 2009.
Ward Name Bed Strength Admission Discharge Deaths Admission / Day Discharge / Day Mortality Rate (%) Bed Occupancy Rate (%) Average Patients No. of OPDs Outdoor Patients No. of Operation Major No. Operation Minor Total Operations Surgical Unit-III Ward-26 40 1205 1140 32 3.12 3.12 2.73 75.04 144.69 102 14758 (539) (1390) (1929)

Activities
We have a well planned teaching program both for under graduate and postgraduate students. Postgraduate Program Bed side clinical teachings and case discussions. Morning meeting daily. Emergency case discussions. Journal Club. Clinico -Pathological conference once a month. Radiological conference once a month. Surgical conference once a month. Surgical audit & morality meetings once a month. For Undergraduates. Morning and evening classes. Final Evaluations ward test and grading (clinical assessments) V year lecture programmes. Coordinating undergraduate teaching of Sindh Medical College & JPMC.

Achievements during the year.
We have done workshop on Basic Laparoscopic skills. PTC workshop.

DEPARTMENT OF THORACIC MEDICINE
ANNUAL ACTIVITIES
The Department of Chest Medicine was housed in old prepartition barrack, now with support of philanthropists and government resources the new building of Chest ward has been constructed having 60 general beds and six bedded Intensive Care, with facility of invasive and noninvasive ventilation. This unit also has a bronchoscopy suite, lung function laboratory and special asthma clinic with a centre for diagnosis and treatment of Tuberculosis under the National T.B control program. The Department is also computerizing the in-door patients data for which a special soft-ware developed, meeting the requirements. The Department has established an Internet Café for postgraduate doctors attached to this unit. Recently service of pleuroscopy has been started for diagnosis of pleural diseases. The Department of Chest Medicine is providing training in field of Respiratory Medicine leading to M.D MCPS, D.T.C.D, F.C.P.S,. A total 24299 patients were seen during current fiscal year in the outpatients and 1310 patients were treated as in-patients in ward-12 & 13. As per tradition in the year 2005-2006 this department organized a number of activities, which included seminars, symposia, and actively participated in conferences and published papers in local and international journals.

Undergraduate Teaching Program
Department of Chest Medicine providing the teaching facilities to undergraduate students for IIIrd year, IV year and V year. Department of Chest Medicine is providing the clinical Pharmacy training under a senior consultant for one week duration on rotation basis for each batch from University of Karachi. Department of Chest Medicine is also providing the teaching services to Medical Technologist trainee students from Dow Medical University, Karachi.

ACADEMIC ACHIEVEMENTS
Candidates awardedDTCD-2008 – 2009 1. Dr. Asad Ali 2. Dr. Rizwan-Ul-Huda 3. Dr. M. Jawad Nazimi 4. Dr. Nazir Ali 5. Dr. Imtiaz Ali Shah 6. Dr. Ghulam Murtuza 7. Dr. Ghulam Abbas.

Services for in and out Patients
For the year 2009. - Chest Intubation - Pleural Biopsy - Lung Biopsy - Pleural Fluid Aspiration - Gastric Lavage AFB Smear - Dressing Chest Tube Washing - Bronchoscopy - Pleuroscopy 310 120 39 312 233 1807 164 17

SYMPOSIA,SEMINARS AND CME ACTIVITIES
1. Attended a MDR TB workshop in Turkey from 26th January, 2009 to 30th January, 2009. 2. Arranged International Conference on Tuberculosis COPD/HIV collaboration with Pakistan Chest Society in Hotel Pearl Continental on 21st and 22nd Feb, 2009. 3. Seminar held on World T.B Day in lecture hall of ward-7 on 24th March, 2009. 4. Visit to Pulmonology at Services Hospital / SIMS & Fatima Memorial Medical & Dental College Lahore on 15th April, 2009 by CPSP. 5. Attend the meeting of National Commission for Non Communicable disease in Pakistan at PMRC, Islamabad on 16th April, 2009. 6. Attended Chronic Respiratory Disease Commission meeting at Islamabad on 1st and 2nd May, 2009 by ministry of Health, Islamabad. 7. Article Published in daily Muqadma on 31st May, 2009 ( Evil of Tobacco). 8. World no Tobacco day on 14th June , 2009 at PMA house collaboration with Pakistan Chest Society. 9. Prevention of COPD. PMA , Jacobabad collaboration with Chest Department of Chandka Medical College on Oct, 2009. 10. Deliver a lecture on “”Community Acquired Pneumonia”” at Dow University of Health Science on 2nd Nov, 2009 11. Attended PMA meeting and deliver a lecture on “”Prevention of COPD”” at Jaccababad on 7th Nov, 2009. 12. Seminar on World COPD Day and two workshops held in Chest Department on (1). Spirometory (2) Non invasive Ventilator collaboration with Pakistan Chest Society on 18th Nov, 2009, JPMC, Auditorium. 13. A lecture on “ Acute Exacerbation of COPD”” by Dr. Nadeem Rizvi on 12th December, 2009 at Symposium of Liaquat National Hospital.

Papers Presented:
“ Implementation of DOTS for tuberculous patients in tertiary care hospital: does it matter”? 19th European Respiratory Annual Congress Vienna, Austria, September 12-16, 2009.

DEPARTMENT OF THORACIC SURGERY
FACULTY
Dr. S. Waqar Ahmed Dr. Tanveer Ahmed Dr. Niaz Hussain Dr. Khalil Ahmed Associate Professor & Incharge Dept. of Thoracic Surgery Asst. Prof. (current charge basis) Senior Registrar Postgraduate Dr. S. Waqar Ahmed, Incharge Department Thoracic Surgery has been awarded honorary Fellowship (FRCS-Glasg) by Royal College of Physicians and Surgeons, Glasgow in 2009. Following two papers from the Department were published in the Journal of CPSP: 1. “Role Of Urgent Thoracotomy in improving the survival of patients with severe Chest Trauma” 2. “Role of video assisted thoracoscopy in the management of clotted hemothorax” 3. The third paper entitled “Clinical Profile and postoperative outcome in patients with simple and complex Aspergilloma of lung” has been accepted by JCPSP for publication.

Department of Thoracic surgery JPMC is the only department of Thoracic Surgery in the public sector, not only in Karachi, but in the entire province of Sindh. We get referrals from Interior Sindh and Baluchistan. We are on call 7 days a week & look after the various Thoracic Trauma cases coming to JPMC.

FACILITIES
Our department is routinely performing thoracotomies for various diseases like Hydatid Diseases, Bronchiectasis, aspergillomas, Various benign and, malignant tumors and decortications. Apart from this we have a good outcome in the management of Oesophageal Cancers. We also have a facility of thoracoscope, enabling us in evacuation of retained clots without thoracotomy. We also perform rigid Bronchoscopy and Oesophagoscopy. Patients with tight strictures of oesophagus are also referred to us for dilatation. We are also doing Thymectomies for patients of Myasthenia Gravis reffered to us from the Neurology Department with good results. As these procedures are a team effort they are only possible with joint efforts and cooperation of Anesthesia Department and Neurology Department.

POST GRADUATE TRAINING
The department also has the responsibility of training Postgraduates for fellowship in Thoracic Surgery. Presently, there are three Postgraduates registered for fellowship training in Thoracic Surgery. In addition we also train Postgraduates coming to our department on rotations of 2-3 months from JPMC surgical department and also other hospitals like Abbassi Shaheed Hospital, PNS Shifa Hospital and Civil Hospital. We have a regular programmme of bedside teaching, case presentations and Journal Clubs, and hands on experience of trauma management and operative skills.

ACHIEVEMENTS
Dr. Tanveer Ahmed has recently passed his fellowship examination in Thoracic Surgery in first attempt while Dr. Niaz is appearing for his final fellowship examination in March 2010.

DEPARTMENT OF UROLOGY
FACULTIES
Prof.Muhammad Umar Baloch Dr. Qazi Fasih-ud-Din Dr. Shahzad Ali Dr. Khalid Rasheed Dr. Mubashir H. Turi Dr. Mohammad Mansoor Dr. Iqbal Shahzad Dr. Naresh Kumar Professor Associate Professor Assistant Professor Senior Registrar Senior Registrar Senior Registrar Senior Registrar Registrar Vesico-vaginal Fistula Paus Meeting 2009 Experience Of Radical Cystectomy at JPMC Paus Meeting 2009

POSTERS:
Cystoscopic Evaluation Of Genito-urinary Fistula—AKUH Symposium

FACILITIES
It is a 26-bedded department with all facilities for Urological surgery including emergencies, endoscopic and open surgery. Total 902 patients were admitted and 1880 major and minor surgical procedures carried out in the 3-suite urology operation theatre.

TRAINING
There is hands on training of different endoscopic and open surgical procedures. Endovision camera also being used for training.

POSTGRADUATES
FCPS-II: MS: Five One

ACTIVITIES
1. Routine activities include out-patient clinics thrice a week attending 12861 patients per year. Operative days are thrice weekly. Daily teaching round with grand round on Saturday are being held followed by discussions, case presentations and morbidity/mortality meeting. 2. Good clinical practice workshop held from 22nd to 23rd January 2010. 3. Meeting of PAUS held in the month of September, 2009. 4. Combined Nephrourology clinico pathologic conference is being held every week.

UNDERGRADUATES
There is a structured teaching program for undergraduates actively carried out by Unit Incharge and Senior Registrars.

RESEARCH
Following research projects were carried out during the year 2009: PAPERS READ AT SCIENTIFIC MEETING. Scrotal abscess:is testicular preservation beneficial? JPMC SYMPOSIUM 2009 Complications of URS JPMC SYMPOSIUM 2009 Penile gangrene JPMC SYMPOSIUM 2009 Improvising our technique of posterior urethroplasty JPMC SYMPOSIUM 2009 State of art lecture on flap urethroplasty in Symposium at Kidney Centre 2009 Genito-Urinary Tuberculosis –PAUS MEETING 2009

FEDERAL GOVERNMENT OFFICERS’ WARD, JPMC
The Federal Government Officer’s Ward, JPMC, is a 35 bedded Ward which has about 60% bed occupancy. It is committed to providing comprehensive medical facilities to high government officials from grade 16 above and also private paying patients from all over the country particularly Karachi and Interior Sindh Government official are admitted in different categories of rooms according to their grades and they have to pay only diet charges. Private paying patients are admitted by the consultants and they have to pay room charges, operation and investigation charges, they get the best possible attention and medical care and at the same time this ward generates revenue for the government as well. The patients are admitted through Out-Patients department ( OPD’s) or transferred from General Ward, Accidental & Emergency ward or Intensive Care Unit. A brief account of admissions during the years is as follows:Total No. of Admission. Total No. of Non Govt. Servants. Total No. of Federal Govt. Servants. Total No. of Discharge. Total No. of Death. 561 456 105 529 022

4. Catering & Kitchen Facilities:There is a separate Kitchen to cater to the patients where whole some meals, both English and Pakistani diet is served at nominal rates charges.

5. Equipment:X- Ray Facilities, Blood Sugar, E.C.G. Machine, BP Monitor Nebulizer, Suctions Machine, etc are available.

6. Academic Activity:Medical Officers who want to do post graduation gain rich experience & knowledge due to variety of patients being managed here.

7. Renovation Work:During the year under report better facilities have been provided by repair and renovation of furniture, room to room distemper painting and polishing work of this Officers ward. It is strongly appreciated that, Executive Director JPMC is taking keen interest in renovation and maintenance of FGO Ward. In her kind guidance and auspicious control F.G.O. Ward has performed out standing and towards better facilities.

( Death are mainly due to terminally ill patients of cancer)

1. Ward Administration:This ward is Directly under Professor Dr. Tasneem Ahsan who is the Executive Director, JPMC. 1. DR. ARIFA AKRAM. (Senior Medical Officer & Incharge of Federal Government Officer Ward) 2. Dr. Nosheen Rauf. (Medical Officer and Administrative R.M.O. F.G.O. Ward) 3. Dr. Uzma Batool Kiyani, (Medical Officer) 4. Dr. Nasreen Fatima. (Medical Officer) 5. Dr. Salma Haj. (Medical Officer) 6. Dr. M. Arshad. (Medical Officer) 7. Dr. Saleem Shahzad. (Medical Officer) All R.M.O.s and Medical Officers offer services to the patients round the clock.

2. Nursing Care:There is one Head Nurse and eight Staff Nurses who work in shifts to provide nursing care to the patients.

3. In- Door Facilities:There are 35 Rooms including eight VIP rooms each room has One Refrigerator, One T.V with hot water line facilities, three single Airconditioned rooms and 24 ordinary rooms are also available. These rooms are allotted to the Professor of different units and patients are admitted either by the Professors or their Associates and Senior Registrar.

JPMC LIBRARY
FACULTY
Ms Nudrat Ara Alvi Incharge Library

ACHIEVEMENTS AND ACTIVITIES
Latest books and international journals have been purchased. Gazettes of Pakistan have been purchased. Theses of MPhil were received from BMSI. Purchases two newspapers. Backset is prepared for reference purpose Subject-wise theses in chronological order are prepared for reference purpose. National journal list has been compiled. Subject wise WHO collection was arranged in a separate portion. Different delegates have visited the library. Inter library loan facility is provided with the cooperation of medical libraries. Annual symposium of JPMC was held in the library.

Library was established in 1958.Mrs Eileen R Cunningham and Mr. J G Robert Asthon were the pioneers of the library and working on Indiana University Contract. During the first five year the Library was situated in Basic Medical Science Institute building.In1964 the library was moved to a central location in the Jinnah Central Hospital compound. Library collection in the clinical departments of the Jinnah Central Hospital was combined with the original Basic Medical Sciences Library collection. Indiana University support of the library under the contract was withdrawn and Mr.Jakiuddin Ahmed become acting Librarian and receive training in Indiana University under the Indiana University contract, earning the M.A.degree in Library Science. Thereafter with the passage of time more new buildings were constructed to cater to the growing need of various specialties of this hospital. It can now proudly claim to be biggest and best equipped hospital of Pakistan employing highly qualified staff in various specialties to render humanitarian services to the ailing. JPMC meets the highest international standards and produce graduates who assume leadership role in the private and public sectors of Medicine as teachers, clinicians and researchers in health care.

COLLECTION
The library collection is based on a current and backset of periodicals, textbooks and monographs on all phases of medicine, including the basic and clinical medicine and other related subjects. Bound periodicals, loose journals, theses MPhil,FCPS, WHO publications, Government Publications, Proceedings, Pamphlets and Reports.

MEMBERSHIP
All the faculty members, medical officers selected by FCPS (permanent basis) and all the registered postgraduate students of the centre MS,FCPS, MPhil, Ph.D.

SERVICES
For research scholars, library is providing photocopy services, CDROM Medline services, five full text journals, reference articles for dissertation and thesis writing. All the postgraduate students of the centre alongwith the students of BMSI are availing facilities in the library. Library was essential to the development of an effective postgraduate education in BMSI.

TRAINING
The library orientation programme is organized regularly for newly admitted students of MPIL and Ph.D.The course comprises of the basic guideline, for the use of research library, references, bibliographical work.

COLLEGE OF NURSING
FACULTY MEMBERS:
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Ms.Rehana Afghani Ms.Salina Chand Ms.Munira A.Ali Ms.Ruth.K.Alam Ms.Fouzia Mariam Ms.Shahnawaz Ms.Naheed Jamal Ms.Durre Shahwar Ms.Mustaqeema Ms.Musarrat Sadiq Principal Vice Principal Nursing Instructor Nursing Instructor Nursing Instructor. Nursing Instructor Nursing Instructor Nursing Instructor Nursing Instructor Nursing Instructor

EXTRA CURRICULAR ACTIVITIES:
Welcome party for new inductees Annual Picnic Sports Biannual Social Evening+

STATISTIC DATA:
SR # MSc.N BSc.N Induction of Student 1st year (14) 1st year (56) 02ND Year (15) 02ND Year (64) FOLLOWING STUDENTS GRADUATED IN 2009 BSc.N 26 DIPLOMA IN TEACHING ADMINISTRATION 21 DIPLOMA WARD ADMINISTRATION 16 DIPLOMA IN COMMUNITY HEALTH NURSING 10 DIPLOMA IN PSYCHIATRIC HEALTH NURSING 10 DIPLOMA IN ADVANCE MIDWIFERY 05

INTRODUCTION:
1956 The College of Nursing (CON ) , Jinnah Postgraduate Medical Center(JPMC )was established as a joint project of the Government of Pakistan, Ministry of Health and the Government of the United States of America, which offered a combined course for preparation in both Ward Administration. 1957 The first batch of students graduated. 1962 It was decided to offer two separate courses. The first year program was to prepare head nurses and a second year program to prepare teachers. The second year program was offered after successful completion of the first year program.

FACILITIES:
Being a pioneer College of Nursing of the Country the College of Nursing is offering Post base diploma of five discipline in various field i.e DIPLOMA WARD ADMINISTRATION, DIPLOMA IN TEACHING ADMINISTRATION, DIPLOMA IN COMMUNITY HEALTH NURSING, DIPLOMA IN PSYCHIATRIC HEALTH NURSING and DIPLOMA IN ADVANCE MIDWIFERY as well as BSc. Nursing degree and MSc.Nursing degree program Candidates are inducted from all one the Country in all provinus depending on quota.

ACTIVITIES:
Presentations by the students to build confidence among students. Three publications of the MSc.Nursing students in Nursing magazine Salient Voice. Scientific paper presentations in 45TH Symposium (Nursing Session). Poster presentation by the MSc.N student in 47th Symposium. Monthly religious activity i.e. recitation of Quran (monthly)& Eid Melad-un-Nabi, Iftar Parties (annually). Educational visits of the students of Diploma in Community Health Nursing and Psychiatric Health Nursing. Teaching Practice of the students of Diploma in Teaching Administration in different institutions. Annual graduation ceremony of all diploma courses.

MEDICAL RECORD AND STATISTICS DEPARTMENT
The medical records have been recognized today as a major unit of management in determining the quality of medical care rendered to the patients by the hospital. An analysis of medical records allows a Physician to study successes and failures of himself and his colleagues and eliminate the mistakes and go forward rather than duplicating them over and over again. A properly maintained medical record can meet the demand of medical staff, research work and back references. The effective handling of medical record is, therefore, basic to sound hospital organization in as much as it provides the required accurate and adequate medical statistics for all purposes. According to mutual agreement between Ministry of Health, Labour & Social Welfare (Health Division), Government of Pakistan and W.H.O., it was decided to assign Dr. M. Ishida W.H.O. Statistician to “Hospital and Health Centre Statistics Project (PAK – 0057)” in 1967. The purpose of the project was to provide statistical information regarding the activities of Hospitals and Health Centres in curative and preventive medicine and their utilization by various Socioeconomic population groups to develop model procedure for recording activities, number of visits, diagnostic information, treatment and to make special studies relating to the registration of vital events. On the basis of the above project a Plan to create a new Department of Medical Records and Statistics in JPMC was formulated and submitted to Health Division, Government of Pakistan in May, 1969. Jinnah Postgraduate Medical Centre is one of the prime medical complexes in Pakistan. The hospital renders the services to more than 52 thousand indoor patients, 1 million outdoor patients, 24 thousand emergency patients and 26 thousand operations annually. With the time quantum of maintaining medical records and statistics is increasing significantly. The adhoc activities are: 1. Statistical lectures on Bio-Statistics to M.Phil/Ph-D students of Basic Medical Sciences Institute of JPMC, Postgraduate students of FCPS and to the students of Medical Diploma Courses. 2. The conduct of Entrance Test Examination for Postgraduate Medical Students, School of Physiotherapy Students, School of Nursing students and for Recruitment. 3. Research analysis and guidance to postgraduate medical students in writing their research papers, synopsis and dissertations.

Function of the Medical Record and Statistics Department:
Medical Record and Statistics Department of Jinnah Postgraduate Medical Centre functions under the supervision of a “Medical Statistician who is an M.Sc. (Statistics). This Department maintains the Morbidity, Mortality and Fertility Statistics of J.P.M.C. that includes the indoor and out door patients. There exists a medical record Library in the department for the preservation of the Medical records. Such data is then classified, summarized and analyzed in the department. The regular activities of the department are as follows:1. Preparation of Index Summary sheets. 2. Sorting of Medical records. 3. To make available the records on demand to the Physician for back references and research purposes. 4. To make available the records for issuance of birth, death and medical certificate. 5. To keep the complete returns and accuracy of the census report. Daily monthly and annual summary reports. 6. Correspondence related to statistical data. 7. To deal with the patients referred to JPMC for medical treatment. 8. Supervision of the out door registration counter. 9. Preparation of Monthly, Quarterly and Annual reports of indoor, outdoor, communicable diseases and mentally ill patients. These reports are sent to Bio-Statistics Department of Ministry of Health on a regular basis.

PAKISTAN MEDICAL RESEARCH COUNCIL
FACULTY:
Research Director : Dr. Waquaruddin Ahmed Medical Officer : Dr. Ambreen Arif : Dr. Fareeha Sajjad : Dr. Javeria Waquar Research officer : Miss Safia Bibi (Microbiologist) : Miss Tranum Ruba Siddiqui (Microbiologist) : Mr. Ejaz Haider (Biochemist) Statistical Officer : Mr. Syed Ejaz Alam The PMRC Research Centre at Jinnah Postgraduate Medical Centre, Karachi was established in 1968. The Director Jinnah Postgraduate Medical Centre is the Honorary Director of the centre. The centre has its own building where the land was donated by the host institution while the building was constructed by a philanthropist who supports the janitorial services to maintain the hygiene. This centre is designated as the specialized centre for gastroenterology and hepatology. The centre has an out patients department where patients with gastrointestinal and hepatic disorders are referred from all over the country. A comprehensive clinical and research data on all cases is maintained at this centre.

SUPPORT IS PROVIDED ON:
Study design, determination of Sample size, Sampling Technique, Questionnaire designing & format designing for data entry according to computer software, Data collection, management and analysis

ACTIVITIES:
The department is actively involved in conducting research projects mainly related to gastrointestinal and hepatobiliary diseases, genetic markers, gastrointestinal flora, cytokine analysis and diarrhoeal diseases and trained young researchers in project writing. Project writing is a skill which refines with time and experience. Often lot of time is spent on making projects but major points like sample size, sampling technique, feasibility, costing and collaboration with other department is over looked. To provide the solution young researchers are trained in how to collect a sample size, use of sampling technique, data management and analysis. It has been observed that in most instances projects are made on topics which do not cater to the needs of the population at large but are more individual oriented therefore they are not supported by the funding agency.

TRAINING:
Two doctors were trained in Diagnostic and therapeutic procedures in year 2009

FACILITIES:
Outpatient clinic for G. I., Liver disease and diagnostic procedures/facilities is available at the centre for the following specialties:

RESEARCH:
Research Projects Completed in 2009:- Are cheaper, old time antibiotics still effective in the control of post operative wound infections? - Screening of HBV/HCV by Eliza Methods for Referred patients of the Depts. of JPMC - Trends of HBV/HCV markers in last 20 years - Yield of culture positivity of Helicobacter pylori on CLO + ve

GASTROENTEROLOGY:
Peptic ulcer disease, inflammatory bowel disease i.e. ulcerative colitis, Crohn’s disease, tuberculosis of the GI tract, malabsorptive disorders, cancer of the GI tract and colonic polyps. Upper and lower GI endoscopy and its related therapeutic procedures like dilatation of the strictures, placement of prosthesis, endoscopic gastrostomy, pyloric dilatation, small bowel biopsy, polypectomies.

Research Project – Ongoing HEPATOLOGY:
Diagnosis and management of acute and chronic hepatitis, cirrhosis, and portal hypertension. Procedures like liver biopsy, banding of esophageal varices are done regularly at the centre, specialized procedures like esophageal manometery, ultrasonography and guided biopsies are done when required. - Serial antibody titers of H. pylori after specific treatment - Clearance and rate of transmission of hepatitis C in new born from infected mothers. - Biofilm formation of pathogens isolated from post operative wound infections.

LABORATORY:
This center has adequate biochemistry and microbiology laboratories and trained staff who have worked with several advanced techniques in the field of clinical biochemistry and molecular biology to facilitate research for this unit and others interested to collaborate. The various available techniques are Spectrophotometer, Radial Immunodiffusion, Viral markers of Hepatitis including rapid testing by strip method and ELISA, Immunofluroescence, developed the rapid diagnostic test (CLO) for H pylori (Patent from Govt. of Pakistan)

Publications:
1. Ziadi S, Usmani A, Shokh IS and Alam SE. “Ovarian Reserve and BMI Between Fertile and Subfertile Women”. J. Coll Physicians Surg Pak. 2009 Jan; 19(1):21-4. 2. Qureshi H, Arif M, Riaz K, Alam SE, Ahmed W and Mujeeb SA. Determination of risk factors for hepatitis B and C in male patients suffering from chronic hepatitis. BMC Research Notes 2009, 2:212. 3. Aziz S and Alam SE. Implementation of Directly Observed Treatment Short Course at a Trust Hospotal in Karachi. PJMR. Vol 48: 68-70, 2009.

BIO-STATISTICS
Statistical support is provided in conducting research projects undertaken by researchers and postgraduate students (M. Phil /Ph. D/ FCPS / MD / MS)

4. Baig S, Siddiqui AA, Ahmed W, Arif A, Qureshi H. Frequency of Hepatitis C and D Super Infection in Patients with Hepatitis B Related Complex Liver Disorders. JCPSP 2009, Vol. 19 (11): 699-703. 5. Qureshi H, Arif M, Ahmed W and Alam SE. YMDD Mutation in Pakistani Patient. The comparision of Eastern response with the Western Response. JPMA 2009, Vol 21:50.

ACHIEVEMENTS:
Data analysis of the project “To see if treatment given for hepatitis B and C is according to the protocol and treatment response set by Prime Minister’s Programme

Research activities: Work Output (in Year 2009)
Patients 1048 82 683 49 20 2 10 141 6 55 3533 7377 11958

PROCEDURE COLONOSCOPY ENDOSCOPY SIGMOIDOSCOPY DILATATION STENT POLYPECTOMY BANDING LIVER BIOPSY ULTRASOUND

OUTPATIENTS (OPD) LABORATORY TEST TOTAL

OPD days PROCEDURE days

Saturday & Wednesday Monday, Thursday & Friday

PATIENTS AID FOUNDATION
Following are the members of Patients Aid Foundation Mr. Zahid Bashir Mr. Mushtaq Chhapra Mr. Yunus Bengali Mrs. Shaheen Suleman Mr. Masood Shaikh Mr. Shabbir Dewan Mr. Shabbir Patka Mrs. Anisa Rasheed Khan Mrs. Ghazala Ahmed Mr. Sikander A. Ghulam Ali Mr. Daruis Kandawala Mr. Dawood Baswani Chairman Board of Governors Chairman Executive Committee Treasurer Hon. General Secretary Member Member Member Member Member Member Member Member

ONGOING Project of Medical ICU
Medical ICU is one of the most important departments of C.C.U. (Critical Care Unit). The ward is in dire need of renovation / construction. We hope to bring this ward to the standards that patients and doctors deserve.

FUTURE PROJECTS
Request received from different wards:1. Renovation and construction of first floor at Ward 5. 2. Construction of Resource Training Center at the roof of Gynae OPD 3. Renovation / construction of Chest ward. 4. Dermatology Department requires a Phototherapy System for the treatment of skin diseases. This therapy machine has different models, i.e. HOUVA & PUVA of 32 lamps and 48 lamps, respectively. Please visit our website at www.patientsaidfoundation.org for further information.

Patients Aid Foundation (PAF) established in 1990 is a voluntary welfare organization set up by the concerned citizens to administer to the needs of poor patients at the Jinnah Postgraduate Medical Center, Karachi PAF helps the hospital and patients by providing a wide range of services round the clock. These include a drug bank functioning on a daily basis, providing the deserving with free MRI, CT Scan, Lab tests, Endoscopies, Angiography, Orthopedic, and artificial limbs. PAF also runs free Shuttle Van Services of pick & drop facilities to approx. 3500 Patients per month from the Main Gate of JPMC to different wards. The PAF is engaged with major projects on a yearly basis. These include renovation and construction of buildings duly equipped with the latest medical equipment. The prominent activities carried out by Patients Aid Foundation are: Renovation / Construction of the following wards: i. Accident and Emergency Department & operation Theater ii. Surgical ICU iii. Chest Ward iv. Gynae ward v. Eye Ward vi. Blood Bank Provision of 200 pints of fully screened blood free of cost to the patients on daily basis. Pathological Lab tests and Diagnostics like C.T. Scan, M.R.I. Lab Blankets, Bed sheet, Coffin Sheet for various wards. Medical Equipment provided to Radiology Department. Catheters for Neuro-Intervention to Ward 16 Neuro-surgery

Symposium

Inauguration & plenary session

Zafar Sajjad
Continuous Medical Education The situation in Pakistan
With the exponential growth in our knowledge and understanding of the human body and its physiological and disease states it has became imperative for health care professional to keep them abreast of the current developments. Failure to do so will put the lives of patients under their care at risk. This fact has led to a worldwide recognition of the need of continuous medical education. There are now well developed systems to ensure the quality and quantity of continuous medical education and this is now a statutory requirement in many countries and regions. There are several terms that are used to describe the processes such as recredentialling, revalidation, recertification, relicensure which all seem similar but have different connotations. This presentation will initially look to address these differences and define the meaning and scope of the terms used in the context of continuous medical education. It will also look at the need and application of the various processes. We will also describe a working model that is being used in Pakistan and will define how this can be achieved with limited resources. The current state of affairs in Pakistan with reference to continuous medical education will be reviewed and some suggestion presented for the way forward will be discussed.

Zafar Sajjad, MRCP(UK), FRCR Associate Professor, Interim Chair, Department Of Radiology, Aga Khan University Hospital, Karachi.

Huma Qureshi
Pakistan Medical Research Council Islamabad

“How to improve research culture in Pakistan”
There are many reasons for the non development of research culture in Pakistan, of which Lack of revision of curricula, scarcity of mentors, lack of time to do research due to over work on part of health providers, lack of funding, non paying research job and lack of appreciation of research by users are the main hurdles. Despite constraints, commitment, vigor and persistence always work especially in researchers. Establishment of PMRC centre at JPMC in 1968 is an example of this commitment and vigor. Most of the research on local GI and liver diseases came out of this centre at a time when gastroenterology as a subject was not known and there was no information on liver diseases in Pakistan. Over the years this centre has become the referral centre for this specialty and a hub for information on these diseases. Extensive data from this centre was referred to while making the PC1 on hepatitis. The present survey on the prevalence of hepatitis B and C in Pakistan is an example of commitment and desire of these researchers to develop the baseline values for Pakistan on these diseases. This survey was conducted from July 2007 to May 2008, in collaboration with Ministry of Health, Statistics Division, Federal Bureau of Statistics (FBS) and Pakistan Medical Research Council (PMRC). A sample size of 7000 houses in 350 primary sampling units (PSUs) all over Pakistan was calculated by FBS, thus requiring checking of 47000 persons. Whole blood devices were used and their sensitivity and specificity was checked against ELISA using serial dilutions. Only devices having an over 98% sensitivity and specificity were used. A total of 47043 persons were screened. Overall prevalence of hepatitis B (HBsAg) was 2.5% and hepatitis C (HCV) was 4.9%. HBeAg positivity in HBsAg positive cases was 14.4%. For HCV the prevalence within provinces showed 5% in Sindh, 6.7% in Punjab, 1.1% in NWFP and 1.5% in Balochistan. For HBV the figures were 2.5% in Sindh, 2.4% in Punjab, 1.3% in NWFP and 4.3% in Balochistan. The sample size was more targeted towards getting the country and provincial prevalence, therefore although all districts were checked but their figures can not be used as the real prevalence in each district. Of the risk factors for disease transmission, therapeutic injection use due to various ailments was high and showed strong positivity to HCV prevalence and about 30% of the screened population was taking more than 5 injections per person per year. The positivity of HCV was twice more in those where a syringe was reused. Operations, hospitalization and blood transfusions came out as the next important risk factors indicating improper sterilization of invasive medical devices and improperly screened blood use in our population To control the disease in Pakistan, one has to increase the hepatitis B vaccination in newborns and high risk groups. For HCV the use of therapeutic injections has to be curtailed to a minimum of 3-4 injections per person per year with stronger injection safety measures.

Shaukat Ali Jawaid
Chief Editor, Pulse International, Managing Editor, Pakistan Journal of Medical Sciences

“Symposium, Past, Present and Future”
My professional love affair with medical journalism started in 1966 and if I recall correctly in those days the JPMC annual symposium used to be the only worthwhile academic activity in Pakistan. It was considered to be an honour to be invited as one of the guest speakers at the JPMC symposium and those whose presentations were accepted after scrutiny also considered it a privilege. Lecture hall at the BMSI was the venue and inauguration itself used to be a very simple affair. Just Cookies with tea were served during the tea break. The symposium always attracted eminent members of the medical profession from all over the country. Apart from this there used to be a session on Medicine in the Pakistan Science Conference while PMA’s biennial conference also had some scientific programme which with the passage of time has almost disappeared. Things have changed a lot since then. In mid 70s some other institutions also started holding seminars and symposia.. The more conscious among the presenters used to travel with their own slide projectors. However, the real impetus to academic activities got when the Association of Pakistani Physicians of North America (APPNA) started holding its meetings in Pakistan every year encouraged by the government of the day. Advances in information technology replaced slide projectors and OHP with Multimedia with the result that tremendous improvements in the quality of slides and presentations was witnessed. Later on a number of specialty organizations were formed which started holding their own annual and biennial conferences and one witnessed academic activities all of the country on regular basis. Thanks to the generous support by the pharmaceutical trade and industry these academic activities shifted from medical institutions to the five star hotels. Now there are too many conferences, seminars and symposia being organized by different institutions and specialty organizations but except a few, most of them can be termed as social get together. Academics has gone in the back ground while there is too much emphasis on lunches, dinners, entertainment and musical programmes and a lot goes on under the disguise of these so called music and variety programmes all sponsored by the pharma industry. Most of the participants are seen visiting pharmaceutical company stalls collecting gifts and samples or enjoying pharma industry hospitality in the exhibition area. Attendance in scientific sessions is most often very thin but it suddenly increases at the time of lunch and dinner. Often there is no scrutiny of abstracts submitted for presentations. It is the quantity and not quality which matters. Protocol and security in case some VIP has been invited as chief guest takes lot of time. Scientific sessions start late and time management is extremely poor. After the presentations, most often no time is left for discussion. The chair persons fail to monitor the speakers to restrict to the allotted time.

More recently some conference, symposium organizers have assumed the role of Medical Nazims and their main emphasis always is in generating as much funds as possible. Pharma trade and industry is ordered and at times coerced to cough up huge amounts. Not only that the industry is also ordered to register delegates which is also meant to generate more funds which are used for providing expensive conference bags, lunches and dinners at these five star hotels . Eventually the pharma industry passes on all this to the patients in the form of expensive drugs and medicines which are beyond the reach of common man. High cost of drugs is also one of the important reasons for failure of compliance with drug therapy. In many cases, conference accounts are neither audited nor presented in the GB meeting though there are a few exceptions. This also gives rise to various disputes among the members leading to court cases. Symposium by any institution should prove to be a show case of its original research and other academic accomplishments which should be presented and in case they do not have anything worthwhile to present, I feel there is no need to have a symposium. The quality and standard of JPMC symposium has also witnessed many ups and downs depending upon the chairperson of the organizing committee and his/her team. In some cases the symposium has just been a formality. It is high time that the members of the medical profession go back to the auditoriums and lecture halls of medical institutions from the Banquet Halls of Five Star Hotels. This will reduce the cost of these academic activities drastically and the funds thus saved can be used for improvement of services, equipping and expanding facilities, and funding research projects or to provide stipends to the postgraduates in addition to provision of books, journals and updating library facilities within the wards and the institutions. Scientific committee should scrutinize all abstracts and select only those which are worth presentation. There should be few papers in a session and the speakers should be asked to stick to the timings. Adequate time should be provided for discussion after every presentation or at the end of each session. Making a presentation is also an art which one has to learn. Poor quality of slides and presentation not only reflects badly on the presenters but on his/her seniors, unit and above all the institutions itself. We can have a central body which can issue CME credit hours for all these academic activities based on the quality of scientific programmes which can be used for re-certification of doctors at a later stage. Only accredited professional specialty organizations, associations should be permitted to organize these meetings and ask for funding from the pharma industry. The accounts must be audited and available on the website of the respective specialty organizations. The presentation will highlight some unethical practices besides offering suggestions to improve the quality and standard of these academic activities.

Scientific Program

SCIENTIFIC PROGRAMME
Jinnah Post Graduate Medical Centre, Karachi. 47TH Annual Medical Symposium
(J.P.M.C. – N.I.C.V.D. – N.I.C.H.)
From 15th February 2010 to 21st February 2010

Theme: Role of Symposia in Education & Research
Date of Session Specialty Mon. 15th Feb.
Inauguration & Plenary Session - Najmuddin Auditorium Ophthalmology - Library Building Hall Najmuddin Auditorium Auditorium Hall-A Main Hall General Medicine, Endocrine Gastroenterology, Dermatology, Hematology, Cardiology Rheumatology Paeds Medicine & Surgery at N.I.C.H. Auditorium Najmuddin Auditorium Main Hall General Surgery, Colorectal, Gastrointestinal, Hepatobiliary, Laparoscopy, Plastic Surgery, Thoracic Auditorium Hall-A Urology Dermatology Auditorium Hall-B Breast Thyroid Auditorium Hall-B Nephrology Chest

Tue.

16th

Feb.

Wed. 17th Feb.

Anatomy, Physiology, Biochemistry, Pharmacology, Histopathology, Microbiology, Clinical Pathology at BMSI Hall Nursing & Paramedics at Library Building Hall Gynecology & Obstetrics at Najmuddin Auditorium Main Hall E.N.T Head & Neck at Library Building Hall Neuromedicine, Mental Health, Neurosurgery at Najmuddin Auditorium Main Hall Dentistry & Maxillo-Facial - Library Building Hall Orthopedic & Trauma, Plastic, Reconstruction, Hand, Micro-Surgery, Paeds Orthopedic Najmuddin Auditorium Main Hall Radiotherapy - Oncology - Cancer OPD Hall, JPMC Anesthesia / Intensive Care / Pain Management - Library Building Hall Najmuddin Auditorium Main Hall Ultrasound / Color Doppler

Thur. 18th Feb. Fri. 19th Feb.

Sat. 20th Feb.

Sun. 21st Feb.

Auditorium Hall-A CT / MRI

Auditorium Hall-B Radio-Isotope & Dexa Scan

CONCLUDING SESSION: Najmuddin Auditorium

SCIENTIFIC SESSION: OPHTHALMOLOGY
MONDAY 15TH FEBRUARY 2010 - TIME 11:30 AM TO 2:00 PM VENUE: LIBRARY BUILDING HALL
JURY MEMBERS FOR BEST PAPER AND POSTER DR. NISAR SHEIKH (ASH) DR. SHARMEEN AKRAM (AKUH)

SESSION (11:30 am - 2:30 pm)
Chairman Co-Chairman Secretary S# PROF. ARSHAD SHEIKH DR. MISBAH AZIZ DR. ALYSCIA CHEEMA

FREE PAPER (10 minutes each)
Name of Presenter TOPIC Prevalence of subtypes and severity of red green color vision deficiency in medical students of Karachi. Outcome of dacrocystorhinostomy for acquired nasolacrimal duct obstruction at 4 months follow up Corneal endothelial cell density in open glaucoma patients using specular microscopy Beta radiation therapy for appropriate ocular lesions Time 11:30 - 11:40 11:41 - 11:50 11:51 - 12:00 12:01 - 12:10 1. Mr. Shahzaib Pervez 2. Dr. Atiq ur Rehman 3. Dr. Saima Majid 4. Dr. Mohd Ali Memon

INVITED TALK (25-30 minutes each)
1. Prof. Wajid Ali Khan Corneal Stem cell transplant 2. Prof. Mohd Moeen Lid reconstruction Question and Answer session 12:30 - 1:00 01:01 - 01:30 01:31 - 02:00

CLOSING OF SESSION BY THE CHAIRMAN REFRESHMENTS (2:00 pm onward) ORGANIZING COMMITTEE
PROF. JAVED H. NIAZI DR. ALYSCIA CHEEMA DR. SABEEN DR. VASDEV HARANI DR. HUMAIRA MEHBOOB DR. QURATUL AIN
COURTESY:

DR. SHAISTA SHAUKAT DR. ARIF RABBANI DR. ATIQ UR REHMAN

SCIENTIFIC SESSION: GENERAL MEDICINE
TUESDAY 16TH FEBRUARY 2010 - TIME: 8:00 AM TO 02:30 PM VENUE: NAJMUDDIN AUDITORIUM MAIN HALL
JURY MEMBERS FOR BEST PAPER
PROF.KHAWAR A .KAZMI PROF.M.H.OSMANI PROF.ABU NOEM FAROOQUI PROF. ASAD SADIQ PROF.FASIHA BASHIR PROF. SALEEMULLAH PROF. MASHOOR ALAM

JURY MEMBERS FOR BEST POSTER
PROF. JAMAL AHMED DR.ISHAQUE GHORI DR. ASHFAQUE

FIRST SESSION (8:00 am - 11:00 am)
Chairman Co-Chairman Secretary Moderator S# 1. 2. 3. PROF. MASHOOR ALAM SHAH PROF. SHABEER HUSSAIN DR. RUKHSANA SATTAR DR. TAHIR ANSARI

INVITED TALK (25-30 minutes each)
Name of Presenter Dr. Bushra Jamil Prof. Mashoor Alam Shah Prof. S. M. Rab Question and Answer Name of Presenter Dr. Rubaba Khan Dr. Waquaruudin Ahmed Dr. Aiyesha Humaira Dr. Amanullah Abbasi Dr. Shafqat Hussain Dr. Ameet Kumar Lohana Dr. Adeel Akbar Khoja Dr. Muhammad Rizwan Dr. Asmat TOPIC H1N1 infection Present past future aspects of diabetes Profession at cross road Time 8:30 - 8:50 8:50 - 9:10 9:10 - 9:30 9:30 - 9:40

Free paper – 9:40 am onwards (10 minutes each)
S# 1. 2. 3. 4. 5. 6. 7. 8. 9. TOPIC Analysis of acute poisoning during four years period (2005-2008) in national poison control centre JPMC, Karachi. Changing trend of viral hepatitis - A 21 year report from JPMC Thallasemia prevention programme planning and development Fatimid Foundation Clinical characteristics and liver biopsy of chronic hepatitis C non responders and relapsers to previous conventional interferon plus ribavarin therapy ECG findings in acute stroke Occupational exposures to needle stick injury and their associated factors among health care workers in developing country. Patterns of physical activity and its differences among school girls and boys in Pakistan. Hyperglycemic emergencies & its precipitating factors Non invasive predictors of oesophageal varices in patients with hepatitis B and hepatitis C related cirrhosis

Closing of session by the Chairman Tea break & poster presentation (11:00 am - 11:30 am) SECOND SESSION (11:30 am - 2:30 pm)
Chairman Co-Chairman Secretary Moderator S# 1. 2. 3. PROF. SYED HAMID SHAFQAT PROF. TAHIR HUSSAIN PROF. JAMAL ARA DR. TARIQ AZIZ

INVITED TALK (25-30 minutes each)
Name of Presenter Prof. Afzal Memon Dr. Shakeel Baig Mrs. Saima Rasheed Question and Answer session Name of Presenter Dr. Meh Jabeen Dr. Ayesha Waggan Dr. Firdous Jahan Prof. Sultan Ayoub Meo Dr. Fareeha Sheikh Dr. Zeenat Banu Dr. Zeenat Banu TOPIC Toxicology Current management in SLE Nutritional needs of hospitalized patients Time 11:30 – 11:50 11:50 – 12:10 12:10 - 12:30 12:30 – 12:40

Free paper – 12:40 onwards (10 minutes each)
S# 1. 2. 3. 4. 5. 6. 7. TOPIC Relation of brain natriuretic peptide, mean arterial and pulse presssure among normotensive , prehypertensive and hypotensive male cohort. Prevalance and fatality related to methanol poisoning - A 2 year survey of patients in national poison control centre JPMC Karachi. Depression in patients with diabetes mellitus and its relationship with diabetes selfcare, medication adherence and glycemic control. Significance of lung function test (spirometry) in diabetic patients Depression and diabetes in high risk urban population of Pakistan Clinical spectrum of tetanus and factors influencing its mortality in a tertiary care hospital. Dengue fever related acalculus cholecystitis

CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS ORGANIZING COMMITTEE:
PROF. TASNIM AHSAN PROF. JAMAL ARA PROF. S. M. MUNIR DR. M. UMAR FAROOQ DR. SUMERA TABASSUM DR. IMRAN HILAL DR. RAKHSHANDA JABEEN DR. RUKHSANA SATTAR DR. QURBAN SHEIKH DR. RIZWAN DR. TAHIR ANSARI DR. SALMAN DR. SHAHBAZ HAIDER DR. TARIQ AZIZ DR. FURQAN DR. MAIROY MR. ZAFAR DR. KAREEM DR. SUMAYYA

COURTESY:

SCIENTIFIC SESSION: ENDOCRINOLOGY
TUESDAY 16TH OF FEBRUARY 2010 - TIME: 8:00 AM TO 11:30 AM VENUE: NAJMUDDIN AUDITORIUM, HALL-A
JURY MEMBERS FOR BEST PAPER Prof. Najam ul Islam Prof. Naeem ul Haq Prof. Tasnim Ahsan

SCIENTIFIC SESSION (8:00 am - 11:00 am)
Chairman Co-Chairman Secretary Moderator S# 1. 2. 3. PROF. NAJAM UL ISLAM PROF. NAEEM UL HAQ PROF. TASNIM AHSAN DR. NOUREEN AIJAZ

INVITED TALK (20 minutes each)
Name of Presenter Dr. Mussarat Prof. Najmul Islam Prof. Syed Jamal Raza TOPIC B-cell mass and its dysfunction in type-I & II DM Endocrine hypertension Disorders of growth development Time 8:30 - 8:50 8:50 - 9:10 9:10 - 9:30

FREE PAPER (10 minutes each)
1. 2. 3. 4. 5. 6. 7. 8. Dr. Rukhshinda Jabeen Dr. Musarrat Riaz Dr. Shazia Kiran Dr. Tamseela Ahmed Dr. Asma Ahmed Dr. Saima Ghaus Dr. Shahid Ahsan Dr. Asma Ahmed Clinical spectrum and various forms of thyrotoxicosis in Endocrine Clinic Assessment of insulin resistance in South East Asia Women with Polycystic Ovarian Syndrome. Association of FTO & MC4R genes with obesity-related traits and type-II DM in Pakistani Population An audit of pituitary tumors in patients presenting to Endocrine Clinic over a period of 3-1/2 years. Comparison of metabolic syndrome prevalence in type-II DM using NCEP ATP-III, IDF & WHO criteria Confusing phenotypes of polycystic ovaries in Endocrine Clinic Is serum adiponectin a precursor of type-II DM? Diabetes related knowledge among residents & nurses: A multi-centre study in Karachi 9:30 - 9:40 9:40 - 9:50 9:50 - 10:00 10:00 - 10:10 10:10 - 10:20 10:20 - 10:30 10:30 - 10:40 10:40 - 10:50 10:50 - 11:00

Question and Answer sessions

CLOSING OF SESSION BY THE CHAIRMAN REFRESHMENTS (11:00 am - 11:30 am) ORGANIZING COMMITTEE
PROF. TASNIM AHSAN DR. M. UMAR FAROOQ DR. ZEENAT BANO DR. IMRAN HILAL DR. MAHESH DR. SAADAT ALI DR. SAMAR ABBAS JAFFERY DR. NOUREEN AIJAZ DR. SUBHEEN KANWAL
COURTESY:

DR. SAIMA GHAUS DR. RAKHSHANDA JABEEN DR. ZAFAR NASIR DR. FURQAN KHAN DR. AMEEN ZUBAIR

SCIENTIFIC SESSION: NEPHROLOGY
TUESDAY 16TH FEBRUARY 2010 TIME: 8:00 AM TO 11:30 AM VENUE: NAJMUDDIN AUDITORIUM - HALL B
JURY MEMBERS FOR BEST PAPER AND POSTER Prof. Fazal Akhtar Dr. Bilal Jamil Dr. Manohar Lal

SCIENTIFIC SESSION (8:00 am - 11:00 am)
Chairman Co-Chairman Secretary Moderator 1. 2. 3. 4. 5. 6. 7. Dr. Kaneez Zehra Dr. Maseer Ahmed Dr. Asifa Khurram Dr. Pooran Mal Dr. Nausheen Iqbal Dr. Dileep Kumar Dr. Bhagwan Das PROF. S.A JAFFAR NAQVI DR. ABDUL MANAN JUNEJO DR. DILEEP KUMAR DR. DARSHAN LAL

FREE PAPER (10 minutes each)
Frequency of the malnutrition and inflammation complex syndrome(MICS) Prevalence of urinary tract infection in pregnancy at JPMC Frequency of pattern and potentially reversible risk factor of left ventricular dysfunction in hemodialysis patients Frequency of Hepato-Renal syndrome in patients with liver cirrhosis associated with Hepatitis C Virus at JPMC Frequency of different pattern of renal osteodystrophy in end stage renal failure patients on maintenance hemodialysis Two years experience of renal amyloidosis at JPMC Left ventricular hypertension in end stage renal disease patients on maintenance hemodialysis 8:30 - 8:40 8:41 – 8:50 8:51 – 9:00 9:01 – 9:10 9:11 – 9:20 9:21 – 9:30 9:31 – 9:40

INVITED TALK (20 minutes each)
1. 2. 3. Prof. S.A Jaffar Naqvi Cardio-Renal Syndrome Prof. S. Anwar Naqvi/ Nephrolithiasis Dr. Manzoor Hussain Dr. Manohar Lal Chronic Kidney Disease Question and Answer session 10:00 – 10:20 10:21 – 10:40 10:40 – 11:00

CLOSING OF SESSION BY THE CHAIRMAN TEA BREAK & POSTER PRESENTATION (11:00 AM – 11:30 AM) ORGANIZING COMMITTEE
DR. MANOHAR LAL DR. ABDUL MANAN DR. KASHIF GULZAR DR. DARSHAN LAL
COURTESY:

DR. TAUQEER ANJUM DR. SANTOSH DR. DILEEP KUMAR

Mission
Pharmaceutical

SCIENTIFIC SESSION: CARDIOLOGY
TUESDAY 16TH FEBRUARY 2010 - TIME:11:30 AM TO 2:30 PM VENUE: NAJMUDDIN AUDITORIUM, HALL-A
JURY MEMBERS FOR BEST PAPER Prof.Asadullah Kundi Dr.Syed Zahid Jamal Dr.Zia Yaqoob Dr.Fawad Farooq Chairman Co-Chairman Secretary / Moderator S# 1. 2. PROF. KHAN SHAH ZAMAN PROF. ARIF UR REHMAN DR. TARIQ MASOOD JURY MEMBERS FOR BEST POSTER Dr.Tariq Ashraf Dr.Syed Ishtiaq Rasool Dr.Sultana Habib

SCIENTIFIC SESSION (11:30 am - 2:30 pm)

FREE PAPER (10 minutes each)
Name of Presenter Dr. Sultana Habib Dr. Fareena Khan TOPIC Size of radial and ulnar artery in local population. Coronary arteries occlusion sites and left ventricular dysfunction in patients visiting Karachi institute of Heart Diseases Frequency of coronary artery stenosis among patients of stable angina having left bundle branch block: effects of gender and age Qualitative and quantitative assessment of coronary arteries in Pakistani population on angiographic study Predictive value of Pathological q waves for fixed perfusion defect and its impact on LV function estimated by gated SPECT Prevalence of positive gated myocardial SPECT in diabetic and non diabetic women and impact on other risk factors To determine prevalence of non compliance in heart failure patients and frequency of various reasons of non compliance. 5-azacytidine and zebularine enhance cardiomyogenic potential of rat bone marrow mesenchymal stem cells in vitro Prognostic value of normal exercise 99mTc-Sestamibi myocardial perfusion imaging in Pakistani population Comparison of risk factors of coronary heart disease in young individuals as compared to older people at Rawalpindi Prospective coronary catheterization registry database at KIHD; non-availability of huge funding is not an issue
Frequency and predictors of cognitive decline in patients undergoing CABG surgery in mixed Pakistani population Coronary arteries occlusion sites and LV dysfunction in patients visiting KIHD Evaluation of congenital heart disease by multi-detector CT

Time 11:30 - 11:40 11:40 - 11:50

3.

Dr. Abbas Raies Abbas

11:50 - 12:00

4. 5. 6. 7. 8. 9.

Dr. A. Rasheed Khan Dr. Nousheen Fatima Dr. Maseeh uz Zaman Dr. S. Fayyaz Mujtaba Dr. Nadia Naeem Dr. Hasan Raza

12:00 - 12:10 12:10 - 12:20 12:20 - 12:30 12:30 - 12:40 12:40-12:50 12:50-13:00 13:00 - 13:10 13:10-13:20 13:20-13:30 13:30-13:40 13:40-13:50 13:50-14:00

10. Dr. Sidra Farooq 11. Dr. Farhan ul Haq 12. Dr. Sultana Habib 13. Dr. Fareena Khan 14. Dr. Rukhsana Tariq

Question and Answer session

CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS ORGANIZING COMMITTEE:
DR. ZAHID JAMAL DR. FAWAD FAROOQ
COURTESY:

DR. ASHA KUMARI

SCIENTIFIC SESSION: CHEST MEDICINE
TUESDAY 16TH FEBRUARY 2010 / TIME: 11:30 AM TO 2:30 PM VENUE:NAJMUDDIN AUDITORIUM, HALL-B
JURY MEMBERS FOR BEST PAPER Dr. Mir Saleem Dr. Ghazala Ansari

SCIENTIFIC SESSION (11:30 am - 2:30 pm)
Chairman DR. IFTIKHAR AHMED Co-Chairman DR. ZAFARYAB HUSSAIN Secretary / Moderator DR. MIRZA SAIFULLAH BAIG

INVITED TALK (25-30 minutes each)
S# Name of Presenter 1. Dr. Sohail Akhter 2. Dr. Nawal Salahuddin TOPIC Asthma control can we achieve the goal Assessment and Management of Hospital Acquired Pneumonia Time 11:30 - 12:00 12:00 - 12:30

FREE PAPER (10 minutes each)
S# Name of Presenter 1. Dr. Shahina Qayyum 2. 3. 4. 5. 6. 7. 8. Dr. Fakhir Raza Dr. Nisar Rao Dr. Farooq Oighur Dr. Rabia Aamir Dr. Nadia Sharif Dr. Noureen Hanif Dr. Babar Dildar TOPIC Comparison of Daily Versus partially Intermittent Regimen of ATT (Ethambutol, Pyrazinamide, INH, Rifampicin) in non HIV with new Pulmonary Tuberculosis (TB) in DOTS program To determine the frequency of depression in Chronic Obstructive Pulmonary Disease (COPD) patients Initial default of Pulmonary Tuberculosis patients in a chest clinic in Karachi Tobacco Cessation Treatment: Knowledge, attitude and practice of Physician in Karachi Comparison of Pleuroscopy and Abrams biopsy in the diagnosis of Exudative Pleural Effusion Atypical Pathogens in adults with Community-Acquired Pneumonia in Pakistan To assess effectiveness of BiPAP in COPD patients with type II respiratory failure with decreased conscious level The Influence of Age and Gender on proper use of Metered Dose Inhaler Time 12:30 - 12:40 12:40 - 12:50 12:50 - 13:00 13:00 - 13:10 13:10 - 13:20 13:20 - 13:30 13:30 - 13:40 13:40 - 13:50

CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS TEA at 2:00 pm ORGANIZING COMMITTEE:
PROF. NADEEM RIZVI DR MIRZA SAIFULLAH BAIG DR KAMRAN KHAN DR MALIK ABID DR DILLEP KUMAR DR NAUSHEEN AHMED DR RABIA JAVAID DR FAKHIR RAZA DR GHULAM SIDDIQUE BURGRI DR BABRA MUGHAL DR NAYYER ABBAS DR MOHAMMED TAUFIQ
COURTESY:

DR Z.HABIB BAIG DR KAMRAN SOOMRO DR FARHAN IBRAHIM DR ADNAN AHMED DR SAIMA TAJ DR MOHAMMED AIJAZ DR HUMERA NISAR

SCIENTIFIC SESSION: PEDIATRIC MEDICINE & SURGERY
TUESDAY 16TH OF FEBRUARY, 2010 (09:00AM – 01:00PM) VENUE: N.I.C.H. AUDITORIUM
JURY MEMBERS FOR BEST PAPER Prof. Abdul Ghaffar Nagi Prof. Talat Mehmood Dr. Najma Patel

SCIENTIFIC SESSION (9:00 am - 1:00 pm)
Chairman Co-Chairman S# 1. PROF. SYED JAMAL RAZA DR. JAMSHED AKHTAR

INVITED TALK (25-30 minutes each)
Name of Presenter Dr. Syed Mahfooz Alam TOPIC Rationale use of disease modifying anti rheumatic drugs in children with juvenile idiopathic arthritis Time 9:00 - 9:30

CME (9:30 am - 10:45 am)
1. Dr. Shamvil Ashraf Questions and Answers Diagnosis and management of a child with abdominal mass 9:30 - 10:30 10:30 - 10:45

CLOSING OF SESSION BY THE CHAIRMAN TEA BREAK & POSTER PRESENTATION (10:45 AM - 11:00 AM) SECOND SESSION (11:00 AM - 1:00 PM) FREE PAPER (11:30 AM - 1:00 PM)
Chairman Co-Chairman Secretary 1. Dr. Kashif Abbas PROF. ZEENAT ISANI DR. AMMARA JAMAL DR. TAYYABA BATOOL

FREE PAPER (11:30 am - 1:00 pm)
Anthropometric measurements of newborns in urban Karachi population 2. Dr. Anjum Shahid Blood pressure, body mass index and waist circumference of school going children of Karachi 3. Dr. Syed Muhammad Raees Penile tourniquet syndrome 4. Dr. Nasir Saleem Saddal Audit of neonatal surgery 5. Dr. Najma Patel Scope of percutaneous catheter interventions in children with heart diseases 6. Dr. Ali Faisal Saleem Pan-resistant Acinetobacter in neonates in Karachi 7. Dr. Ali Faisal Saleem Dose prophylactic use of Dexamethasone has a role in reducing post-extubation stridor and re-intubation in children? 8. Dr. Nizam ul Hasan Cytogenetic lab at National Institute of Child Health, it’s value to patients and physicians 9. Dr. Khair-un-Nisa Clinical presentation of coeliac disease in children 10. Dr. Veena Tresa Pathogens of dysentery in children under five years of age and their sensitivity pattern. 11. Dr. Sadaf Asim Anemia in children with chronic kidney disease at National Institue of Child Health, Karachi Question and Answer session 11:00 - 11:10 11:10 - 11:20 11:20 - 11:30 11:30 - 11:40 11:40 - 11:50 11:50 - 12:00 12:00 - 12:10 12:10 - 12:20 12:20 - 12:30 12:30 - 12:40 12:40 - 12:50 12:50 - 13:00

CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS ORGANIZING COMMITTEE:
PROF. SYED JAMAL RAZA DR. JAMSHED AKHTAR
COURTESY:

DR. RANI BENISH

SCIENTIFIC SESSION: SURGICAL & ALLIED
WEDNESDAY 17TH FEB 2010 TIME: 8:00AM TO 2:30AM VENUE: NAJMUDDIN AUDITORIUM- MAIN HALL
JURY MEMBERS FOR BEST PAPER PROF. RIZWAN AZMI PROF. NUSRAT ANIS DR. S. WAQAR AHMED Chairman Co-Chairman Secretary Moderator S# 1. 2. 3. 4. 5. 6. 1. 2. Name of Presenter Dr. Safia Bibi Dr. Sijad Ahmed Dr. Shireen Ramzanali Damani Dr. Syed Shahabuddin Dr. Bilal Fazal Shaikh Dr. S. H. Waqar Prof. Rizwan Azmi Prof. Muhammad Ayaz Question and Answers PROF. ASADULLAH KHAN PROF. WAQAR AHMED DR. NASEEM BALOCH DR. MASOOD RAZA KHAN JURY MEMBERS FOR BEST POSTER PROF. IRSHAD WAHEED PROF. ASADULLAH KHAN DR. SHAHID RASOOL

FIRST SESSION (8:00 am - 11:00 am)

FREE PAPER (10 minutes each)
TOPIC Surveillance for post operative wound infections in general surgery ward of a tertiary care hospital of Karachi Incidence of chronic post operative pain in patients operated for inguinal hernia and its impaction on quality of life Early laproscopic cholecystectomy for acute versus chronic cholecystitis: A prospective comparative study Extending the scope of cardiopulmonary bypass Outcome of reconstructive procedures in Fournier’s gangrene at Liaquat university hospital Jamshoro Two port laparoscopic cholicystectomy; an early experience INVITED TALK (25-30 minutes each) Post graduate medical education, problems and role of CPSP Spleno-Renal shunt portal hypertension the current status Time 8:30 - 8:40 8:41 - 8:50 8:51 - 9:00 9:01 - 9:10 9:11 - 9:20 9:20 - 9:30 9:30 - 10:00 10:00 - 10:30 10:30 - 11:00

Chairman Co-Chairman Secretary Moderator S# 1. 2. 3. 4. 5. 6.

Closing of Session by the Chairman Tea Break & Poster Presentation (11:00 am - 11:30 am) Second Session (11:30 am - 2:30 pm) PROF. IRSHAD WAHEED DR. SAGHEER H. SHAH DR. ZIA-UL- ISLAM DR. ZAHID MEHMOOD

FREE PAPER (10 minutes each)
Name of Presenter Dr. K. M Inam Pal AKUH Dr. Shireen Ramzanali Damani JPMC Dr. Mahesh Kumar LUMHS Dr. Tanveer Ahmed JPMC Dr. Syed Kamran Ahmed Indus Hospital Dr. Shahriyar Ghazanfar TOPIC Evolving approach to neoplasia of the esophagus: Over a decade of experience The effect of ramadan fasting on duodenal ulcer perforation: A Retrospective Study Management of scalp defects Intracavitary drainage of giant emphysematous bullae in patients with poor pulmonary reserve Paired abdominal flap: A reliable hand sandwich for degloving hand injuries To evaluate the effectiveness of endoscopic ballon sphincteroplasty as an adjunct to endoscopic sphincterotomy in removing large and difficult bile duct stones Time 11:30 - 11:40 11:41 - 11:50 11:51 - 12:00 12:01 - 12:10 12:11 - 12:20 12:11 - 12:20

INVITED TALK (25-30 minutes each)
Prof. Mumtaz Maher Obesity Surgery: Current Concepts & Future Perspective 12:30 - 01:00 Prof. Ghulam Asghar Channa Spleno-Renal shunt portal hypertension the current status 01:01 - 01:30 Question and Answer session 01:31 - 01:40 CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS ORGANIZING COMMITTEE: PROF. ANIS SUBHAN DR. SHAHID RASOOL DR. ALI AHMED DR. BASHEER DR. S. WAQAR AHMED DR. FARMAN DR. ALI RIFFAT DR. MIRZA SIKANDER DR. SAGHEER HUSSAIN DR. ZAHID ALI DR. SURRENDER DAWANI DR. ZEEHAN DR. ADEEL HASSAN DR. MANSAB DR. UZAIR DR. IMRAN ADEEB DR. FAHEEM DR. MAHMOODA WASEEM DR. MAHAM YOUSUF DR. M. ARIFUZZAMAN DR. BATOOL DR. MEHVISH NAZEER DR. RABBIYA DR. MOHD USMAN KHAN DR. ZAHID MEHMOOD DR. SALEEM DR. S. ALI MEHSAM
COURTESY:

1. 2.

TYCO

Ethicon

SCIENTIFIC SESSION: UROLOGY
WEDNESDAY 17TH FEBRUARY 2010 - TIME: 8:00 AM TO 11:30 PM VENUE: NAJMUDDIN AUDITORIUM MAIN HALL A
JURY MEMBERS FOR BEST PAPER DR. HAMMAD ATHER (AKUH) DR. MANZOOR HUSSAIN (SIUT) DR. ZAFAR ZAIDI (INDUS) Chairman Co-Chairman Secretary Moderator S# 1. 2. 3. 4. 5. 6. 7. JURY MEMBERS FOR BEST POSTER DR. RAZIUDDIN BIYABANI (AKUH) DR. MUSTANSIR JHAVERI (FH) DR. SALMAN-EL-KHALID (KCK)

SCIENTIFIC SESSION (8:00 am - 11:00 am)
PROF. MASOOD A. SHEIKH (JPMC) PROF. AMANULLAH MEMON (AKUH) DR. IQBAL SHAHZAD (JPMC) DR. SHAHZAD ALI (JPMC)

FREE PAPER 8:30 ONWARDS (10 minutes each)
Name of Presenter Dr. Mustansir Jhaveri Dr. Khurram Siddiqui Dr. M. Mansoor Dr. Naresh Kumar Dr. Rehamatullah Soomro Dr. Rehamatullah Soomro Dr. Syed Johar Raza TOPIC Case report of androgen insensitivity syndrome Laprascopic pyeloplasty : stenting technique Superficial bladder tumors recurrence & progression PCNL-JPMC experience Pre-operative standard informed consent Urethral stricture disease a review Grading complication following radical cystectomy and ileal condiut for bladder cancer 9:30 - 10:00 10:00 - 10:30 10:30 - 10:40

INVITED TALK (25 - 30 minutes each)
1. Prof. Masood A. Sheikh Urinary Tract Infections (UTI) 2. Prof. Amanullah Memon Induratio Penis Plastica Question and Answer session

CLOSING OF SESSION BY THE CHAIRMAN TEA BREAK & POSTER PRESENTATION (11:00 AM – 11:30 AM) ORGANIZING COMMITTEE
DR. UMER BALOCH DR. SHAHZAD ALI DR. M. MANSOOR DR. SHAHNAWAZ DR. MANSOOR ALI DR. IQBAL SHAHZAD
COURTESY:

DR. TAUQIR ANJUM DR. NARESH DR. SANTOSH KUMAR

SCIENTIFIC SESSION: BREAST
WEDNESDAY 17TH FEBRUARY 2010 / TIME: 08:00 AM TO 11:30 AM VENUE: NAJMUDDIN AUDITORIUM MAIN HALL B
JURY MEMBERS FOR BEST PAPER Prof. Ghulam Asghar Channa Dr. Sughra Parveen JURY MEMBERS FOR BEST POSTER Dr. Khawar Jamali Dr. Noor Soomro

SCIENTIFIC SESSION (8:30 AM - 11:00 AM)
Chairman Co-Chairman Secretary Moderator PROF. S. H. M. ZAIDI PROF. NAHEED SULTAN DR. SAJIDA QURESHI DR. SALIM SOOMRO

FREE PAPER - 9:00 am onwards (10 minutes each)
S# 1. Name of Presenter Dr. Shireen Ramzanali Damani Dr. Aliya Ishaq Dr. Hina Khan Modified Radical Mastectomy with axillary clearance using harmonic scalpel Malignant phyllodes: Is radiotherapy mandatory? Frequency of triple negative breast cancer

2. 3.

INVITED TALK (20-30 minutes each)
1. 2. Dr. Rufina Soomro Dr. Azmina Vali Muhammad Role of surgery in metastatic breast cancer Triple negative breast cancer 9:30-10:00 10:00--10:30

3.

Question and Answer session

10:30--10:40

CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS Hi-tea (11:00 am - 11:30 am) ORGANIZING COMMITTEE:
DR. SALIM SOOMRO DR. TABINDA ASLAM DR. ANUSANDHIYA DR. REKHA DR. SAMREENA DR. HINA KHAN
COURTESY:

SCIENTIFIC SESSION: DERMATOLOGY
WEDNESDAY 17TH FEBRUARY 2010 - TIME:11:30 AM TO 2:30 PM VENUE: NAJMUDDIN AUDITORIUM HALL A
JURY MEMBERS FOR BEST PAPER Prof. Peter Baillie Dr. Ijaz Ahmed

SESSION (11:30am - 2:30pm)
Chairman Co-Chairman Secretary Moderator S# 1. 2. 3. PROF. AZAM J. SAMDANI DR. SIKANDAR AZAM MAHAR DR. BEHRAM KHAN KHOSA DR. SAMIRA RIZWAN

FREE PAPER (10 minutes each)
Name of Presenter Dr. Sadia Masood Dr. Saadia Tabassum Dr. Abdul Mannan Dr. Maria Farooqi TOPIC Reticulated multifocal fixed drug eruption due to mefenamic acid. Case of non HIV Kaposi sarcoma of skin and gastric mucosa. Frequency of different species of clinically diagnosed Tinea Capitis in children reporting on a tertiary care hospital of Karachi. Assess efficacy of combination of topical 2%minoxidil lotion and isotretinoin 0.05% gel in treatment of Alopecia Areata. Frequency and pattern of nail changes in patients with Psoriasis vulgaris. Age and sex distribution and effect of various factors on the course of acne in patients attending OPD at JPMC Dermatosis with keloid /scars due to DEET <N,N –Diethylmeta – Toluamide.> Two sisters with an interesting presentation of lipoid ptotienosis Famciclovir Evaluation programe Frequency of scabies in rural areas is still primary health care challenge. Time 12:00 - 12:10 12:11 - 12:20 12:21 - 12:30

4. 5. 6. 7. 8. 9. 10.

Dr. Sana Amin Dr. Junaid Rabbani Dr. Ahson Ghias Dr. Qaisra Masroor Dr. Sobia Liaqat Dr. Zafar Alam Dr. Satti Jewat

12:31 - 12:40 12:41 - 12:50 12:51 - 13:00 13:00 - 13:10 13:10 - 13:20 13:20 - 13:30 13:30 - 13:40

INVITED TALK (25-30 minutes each)
1. 2. Prof. Peter Baillie Dr. Abid Azhar The polycystic ovary and its manifestation Congenital skin disorders :A brief overview of the Molecular Genetic Potential. 13:40 - 14:00 14:00 - 14:20 14:10 - 14:30

Question and Answer session

CLSOING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS REFRESHMENT 2:30 pm ORGANIZING COMMITTEE:
DR. SAMIRA RIZWAN DR. BEHRAM KHAN DR. SOBIA LIAQAT DR. AHSAN GHIAS DR. MEHWISH RAZA DR. SONIA RAJPAL DR. ASIF JATOI DR. SHAHNAWAZ DR. ABDUL GHAFFAR DR. QAISRA MASROOR DR. SANAM DAHRI DR. SANOBER MUMTAZ
COURTESY:

DR. SHAHNAWAZ KARIM DR. PARAS NAGPAL DR. NAZIA MEMON DR SHAGUFTA HANIF BAIG DR. YASIR PARACHA DR. NIGHAT BROHI

Shaigan

Derma

SCIENTIFIC SESSION: BMSI
WEDNESDAY 18TH FEBRUARY 2010 - TIME: 8:00 AM TO 02:30 PM VENUE: BMSI HALL
JURY MEMBERS FOR BEST PAPER Prof. Muhammad Saleh Soomro Prof. Khemomal A. Karira Dr. Anjum Naqvi
Chairman Co-Chairman Secretary Moderator PROF. DR. PARWAIZ SANDILA PROF. NAZIR A. SOLANGI DR. SURESH KUMAR DR. UZMA TASNEEM

JURY MEMBERS FOR BEST POSTER Porf. Asif Bhurgri Prof. Saleem A. Kharal Dr. Shehnaz Imdad Kehar

FIRST SESSION (8:00 AM – 11:00 AM)

FREE PAPER (10 minutes each)
S#
1 2 3 4 5 6 7 8 9 10 11 12 13 1

Name of Presenter
Prof. Dr jawed (LCMD) Ms. Sitwat Zehra (KIBGE) Ms. Hira Khan( u Sind) Ms.Farhat Batool (KU) Dr. S. M. Shahid Dr. S.Haider Raza Naqvi Dr. Nazir Solangi (LNH) Ms.Qurratulain (KU) Ms. Huma Ikram (KU) Dr. Hamid Zia Shaikh (ISRA) Dr. Mehjabeen (HCMD) Dr. Humaira Nawab (KMDC) Dr. Khalid Saeed (LCMD) Prof. Dr. Muhammad Ishaq (SSMC) Biochemistry Biochemistry Biochemistry Biochemistry Biochemistry Pharmacology Pharmacology Pharmacology Pharmacology Physiology Physiology Physiology Physiology Genetic Engineering

Time
8:20-8:30 8:31-8:40 8:41-8:50 8:51-9:00 9:01-9:10 9:11-9:20 9:21-9:30 9:31-9:40 9:41-9:50 9:51-10:00 10:01-10:10 10:11-10:20 10:21-10:30 10:30-11:00

INVITED TALK (25-30 minutes each) CLOSING OF SESSION BY THE CHAIRMAN TEA BREAK AND POSTER PRESENTATION
Chairman Co-Chairman Secretary Moderator S# 1 2 3 4 5 6 7 8 9 10 11 12 13 1 PROF. AMEER ALI SHORO PROF. ASIF BHURGARI DR. S. OWAIS AHMED DR. UZMA TASNEEM

FREE PAPER (10 minutes each)
Name of Presenter Prof. Dr. Waseem Iqbal (BMC) Dr. Salman Farooq (AKU) Ms. Saima Saleem (KU) Dr. Shahreera Shakeel Malik (SIUT) Dr. Aftab Ahmed (SOBS) Dr. Abdul Hafiz (BMSI) Dr. M. Saeed Vohra (KS) Dr. Sameera Khursheed (KU) Dr. Wajid Khursheed (BMSI) Dr. Syed Uzair Ali Shah (KU) Dr. Shadab Parveen (KU) Dr. Raziuddin Ahmed (BMSI) Dr. Tarnum Rubab Siddiqui (PMRC) Prof. Dr. Muhammad Anwar Akhund (PMC), Nawab Shah Pathology Pathology Pathology Pathology Anatomy Anatomy Anatomy Anatomy Microbiology Microbiology Microbiology Microbiology Microbiology Swine Flu Time 11:50 – 12:00 12:01 – 12:10 12:11 – 12:20 12:21 – 12:30 12:31 – 12:40 12:41 – 12:50 12:51 – 13:00 13:31 – 13:40 13:41 – 13:50 13:51 – 14:00 14:01 – 14:10 14:11 – 14:20 14:21 – 14:30 13:00 - 13:30

INVITED TALK (25-30 minutes each) CLSOING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS ORGANIZING COMMITTEE:
PROF. SALEEM AHMED KHARAL DR. ABDUL SHAKOOR MEMON MRS. NUDRAT ANWAR ZUBERI DR. SHAHNAZ IMDAD KEHAR

SCIENTIFIC SESSION: NURSING & PARAMEDICS
WEDNESDAY 17TH FEBRUARY 2010 - TIME: 8:00 AM TO 02:30 PM VENUE: LIBRARY BUILDING HALL
JURY MEMBERS FOR BEST PAPER MRS. SUSAN MUNAWAR MRS. AMTUL ANEES MRS. AZRA NASREEN Chairman Co-Chairman Secretary Moderator S# 1. 2. 3. 4. MS. MS. MS. MS. JURY MEMBERS FOR BEST POSTER MRS. MYWISH NADIR KHAN MRS. ASTER GHULAM MS. SHEHLA ZAFAR

FIRST SESSION (8:00 am - 11:00 am)
REHANA AFGHANI ZAIB-UN-NISA RUTH K. ALAM SALINA CHAND INVITED TALK (25-30 minutes each) TOPIC Hazards of needle stick injury Handling and taking over of nurses in clinical setting Importance of research in nursing education and practice Evidence base practice through nursing education FREE PAPER (10 minutes each) Perceptions of nurses about the diploma in teaching and adminsitration nursing programme Karachi, Pakistan Swine flu: information is the best prevention Development of nursing education in pakistan Repeat cranial computed tomography in patents with mild head injury Reasons for unscheduled absenteeism of registered nurses

Name of Presenter Dr. Hasnain Quettawala Ms. Afshan Nazli Dr. Rozina Kamalaini Dr. Alia Nasir Questions and Answers Ms. Durr-e-shahwar Pasha

Time 9:00 - 9:20 9:20 - 9:40 9:40 - 10:00 10:00 - 10:20

1. 2. 3. 4.

10:20 - 10:30

Mr. Hidayatullah 10:30 - 10:40 Ms. Fouzia Naz 10:40 - 10:50 Mr. Manzar Hussain 10:40 - 10:50 Ather Enam 5. Mussarat Fatima & 11:00 - 11:10 Rukhsana Parveen Closing of Session by the Chairman Tea Break & Poster Presentation (11:00 am - 11:30 am) Second Session (11:30 am - 2:30 pm) Chairman MS. REHANA AFGHANI Co-Chairman MS. ZAIB-UN-NISA Secretary MS. RUTH K. ALAM Moderator MS. SALINA CHAND

FREE PAPER (10 minutes each)
S# 1. 2. 3. 4. 5. 6. Name of Presenter Dr. Raisa B. Gul, Ms. Salima Moez & Ms. Rubina Barolia Dr. Raisa B. Gul & Ms. Nuzhat Sultana Ms. Nasreen Ghani & Ms. Shaheen Ghani Ms. Husan Bano Channar Mr. Irshad Akhter Ms. Shabana Wazir TOPIC Implications of faculty members becoming students in the same institution Practice of patients teaching for discharge after day surgery Woman’s perceptions of nursing support during chaild birth Time 11:40 - 11:50 11:50 - 12:00 12:00 - 12:10

Importance of continuing nursing education 12:10 - 12:20 Medication errors in hospital care setting 12:20 - 12:30 Effective clinical teaching is an essential component of nursing 12:30 - 12:40 education program. CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS ORGANIZING COMMITTEE: MS. REHANA AFGHANI MRS. SAFINA LAWRANCE MRS. SHAHNAWAZ Dr. MONICA MS. ZAIB-UN-NISA MRS. ASTER GHULAM MR. SAIF ALI MR. IRSHAD ABBASI MS. RUTH K. ALAM MRS. SHAHEEN KOUSAR MRS. MUNIRA ALI MRS. VIOLET BARKAT MRS. SALINA CHAND MRS. SHAHNAZ BANO MRS. NAHEED JAMAL MRS. UROOGE RASHEED MRS. MUSARRAT SADIQ MRS. NARGIS QURESHI MRS. MARIYUM FOUZIA MR. ZULFIQAR MRS. MUSTAQIMA BEGUM MRS. MUKHTARI SARDAR MR. FAROOQ AHMED MS. SHAMSHAD BEGUM MRS. DURR-E-SHAHWAR MRS. AZRA NASREEN MR. ZAIDULLAH KHAN MR. TAHIR BHUTTO MRS. RIAZ AKHTER MR. ASIF ZIA SIDDIQUI MR. IRFAN AHMED MS. TALAT NOUREEN
COURTESY:

B-BRAUN

SCIENTIFIC SESSION: GYNEACOLOGY/OBSTETRICS
THURSDAY 18TH FEBRUARY 2010 TIME: 8:00 AM TO 2:30 PM VENUE: NAJMUDDIN AUDITORIUM MAIN HALL
JURY MEMBERS FOR BEST PAPER PROF. HASAN FATIMA DR. NAGINA FATIMA DR. RAZIA KOREJO Chairman Co-Chairman Secretary Moderator S# 1. 2. 3. 4. 5. 6. Name of Presenter Dr. Hina Hashmi Dr. Saba Khan Dr. S. Ahmed Dr. Khadija Dr. Afia Ansar Dr. Nasreen Fatima PROF. SADIQUA JAFAREY PROF. SUBHANA TAYYAB DR. SAMIA SHUJA DR. HALEEMA YASMIN JURY MEMBERS FOR BEST POSTER PROF. SUBHANA TAYYAB DR. ASIFA GHAZI DR. SAMIA SHUJA

FIRST SESSION (11:30 am - 2:30 pm)

FREE PAPER (10 minutes each)
TOPIC Pattern of cervical cancer in Kiran hospital. Role of interval hysterectomy and methotrexate in preventing mortality in placenta percreta. First trimester threatened miscarriage and related obstetrical complications. Efficacy and safety of S/C administered erythropoietin along with intravenous Iron sucrose in the management of Iron deficiency anemia in patients awaiting elective gynecology surgery. Predisposing factor of uterine rupture and assessment of fetomaternal out come. Anemia during entinatal period: evaluation of different related perameter in pragnant women Time 8:30 - 8:40 8:40 - 8:50 8:50 - 9:00 9:00 - 9:10

9:10 - 9:20 9:20 - 9:30

INVITED TALK (30 minutes each)
Gyneacological ultrasound 9:30 - 10:00 Doppler ultrasound in Obstetrics and Gynecology 10:00 - 10:30 Obstetric ultrasound 10:30 - 10:40 Closing of Session by the Chairman Tea Break & Poster Presentation (11:00 am - 11:30 am) Second Session (11:30 am - 2:30 pm) Chairman PROF. HASSAN FATIMA JAFERY Co-Chairman DR. ASIFA GHAZI Secretary DR. KHADIJA BANO Moderator DR. AFIA ANSAR FREE PAPER (10 minutes each) S# Name of Presenter TOPIC Time 1. Dr. Arifa Jabeen Kakar Prevalence of vaginal hemolytic 12:00 - 12:10 2. Dr. Iffat Javed Butt Insertion of intra uterine contraceptive device 12:11 - 12:20 3. Dr. Farkhunda Nadeem Frequency of cervical and endometrial........ 12:21 - 12:30 4. Dr. Haleema Yasmin & Knowledge and attitude medical students........ 12:31 - 12:40 Tooba Malik 5. Dr. Sadia Nasim Knowledge regarding TH disease 12:41 - 12:50 6. Mr. Shahzaib Pervaiz Relationship of gestational diabetes mellitus........ 12:51 - 13:00 7. Dr. Ramna Davi Five years experience of ovarian tumor at........ 13:01 - 13:10 8. Dr. Nusrat Nisar Severity menopausal symtoms at ........ 13:11 - 13:20 INVITED TALK (25-30 minutes each) 1. Dr. Sadia Ahsan Pal (NCMNH) Doctors and media 13:30 - 14:00 Question and Answer session 14:01 - 14:30 CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS ORGANIZING COMMITTEE: PROF. SHEREEN ZULFIQAR BHUTTA DR.SAMIA SHUJA DR. HALEEMA YASMIN PROF. NAGINA FATIMA DR. IFFAT ASHER DR. KHADIJA BANO DR. RAZIA KOREJO DR. SAMREEN IQBAL DR. SHAZIA NASEEB DR. KAUSAR ILLAHI BUKSH DR. AYESHA NASIR DR. AFIA ANSAR
COURTESY:

1. 2. 3.

Dr. Tanveer Zubairi (TUC) Dr. Musarrat Hasan Dr. Shahida Zaidi (ZUC)

SCIENTIFIC SESSION: ENT
THURSDAY 18TH FEBRUARY 2010 - TIME: 8:00 AM TO 02:30 PM VENUE: LIBRARY BUILDING HALL
JURY MEMBERS FOR BEST PAPER Prof. Iqbal Hussain Udaipurwala Prof. Khalid Ashrafi Dr. Shakeel Aqil Chairman Co-Chairman Secretary S# 1. 2. 3. PROF. JAVED ALAM PROF. KHALID ASHRAFI DR. IMTIAZ SIDDIQUI JURY MEMBERS FOR BEST POSTER Dr. Abbas Zafar Prof. Iqbal Udaipurwala Dr. Shakeel Aqil

FIRST SESSION (8:00 AM – 11:00 AM)

INVITED TALK - Time (09:00 am – 10:00)
Name of Presenter Prof. Muhammad Saleem Marfani Prof. Abbas Zafar Dr. Mumtiaz Jamshed TOPIC Spectrum of Laryngeal Pathology Tertiary Care Experience Reconstruction in Head and Neck Surgery The option of oropharyngeal resection PROF. MUMTAZ JAMSHED PROF. IFTIKHAR SALAHUDDIN PROF. KAMALUDDIN KHAN DR. IQBAL HUSSAIN UDAIPURWALA Time 9:00 - 9:20 9:20 - 9:40 9:40 - 10:00

PANEL DISCUSSION ON HEAD AND NECK (TIME 10:00 - 11:00am)
Moderator Panelist

TEA BREAK & POSTER PRESENTATION (11:00 am - 11:30 am) SECOND SESSION (11:30 am - 2:30 pm)
Chairman Co-Chairman Secretary Moderator Panelist DR. MUMTAZ JAMSHED PROF. SALMAN MATIULLAH DR. NASEER AHMED

PANEL DISCUSSION ON OTOLOGY (TIME 11:30 - 12:15 am)
PROF. IFTIKHAR SALAHUDDIN PROF. Q.M.H. JALISI PROF. JAVED ALAM PROF. AZAM YOUSUFANI

FREE PAPER - Time (12:15 am - 02:00 pm) 10 mins each
S# 1. 2. 3. 4. 5. 6. 7. 8. Name of Presenter Dr. Iqbal Hussain Udaipurwala Dr. Arsalan Ahmed Dr. Zubair Anwar Baloch Dr. Aqil Dr. Saba Abbasi Dr. Mehboob Afzal Dr. Imtiaz Siddiqui Dr. Naseer Ahmed Questions and Answers session TOPIC Efficacy of Fat - Plug mringoplasty in small and dry perforation of Pars - Tensa Allergic fungal rhinosinusitis CT findings compare to operaive findings Experience of Carotid body tumor in ENT department of JPMC Pre-Operative findings in Atico-Antral type of CSOM Screening programme for hearing assessment in newborn and children Presentation of Nasopharyngeal Carcinoma Frequency of vestibular neuronitis in vertigo presented at JPMC Preevalence of Chronic sinusitis among outdoor psychiatric patients Time 12:15-12:25 12:25-12:35 12:35-12:45 12:45-12:55 12:55-1:05 1:05-1:15 1:15-1:25 1:25-1:35 1:35-1:45

CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS ORGANIZING COMITTEE:
PROF. TARIQ RAFI DR. SAMEER QURAISHY DR. MOHAMMAD USMAN DR. IMTIAZ SIDDIQUI DR. JAVED JAMALI DR. NASEER AHMED DR. ZUBAIR BALOCH DR. JAN MOHAMMAD
COURTESY:

SCIENTIFIC SESSION: NEUROSCIENCES SESSION
FRIDAY 19TH FEBRUARY 2010, TIME: 8:00AM-1:30PM VENUE: NAJMUDDIN AUDITORIUM MAIN HALL
JURY MEMBERS FOR BEST PAPER JURY MEMBERS FOR BEST POSTER PROF. SHAHID AHMED PROF. A.SATTAR M. HASHIM DR. MUHAMMAD WASAY DR. SARWAR SIDDIQUI DR. NAILA SHAHBAZ DR. ISHAQ SARHANDI FIRST SESSION (8:00 am - 11:00 am)
Chairman Co-Chairman Secretary Moderator S# 1. 2. 3. 4. 5. 6. 7. 8. PROF. HASAN AZIZ PROF. A. SATTAR HASHIM DR. S. WASIM AHMED DR. KHALID SHER FREE PAPER (10 minutes each) Name of Presenter TOPIC Dr.Abdul Basit Outcome of occipital encephalocele Dr.Lal Rehman Role of cloward technique for cervical disc herniation Dr.Manzar Hussain Repeated computed tomography in patients with mild head injury Dr Arshad Ali An early experience of endovascular techniques at first ever public sector unit at JPMC Dr Shamsher Ali Outcome of spinal meningiomas and neurofibromas Dr.Asif A.Qureshi Role of early decompressive craniotomy in the management of head injury Dr. Muhammed Abid 500 Consecutive cases of gamma knife stereotactic radiosurgery Dr. Kauser Mehmood Paroxysmal dyskinesias, a rare movement disorder with intact consciousness INVITED TALK (20 minutes each) Prof. Junaid Ashraf Neurosurgical management of epilepsy, movement & functional disorders; Current practice Dr. Nadir Ali Syed Update on parkinsons disease

Time 8:30 – 8:40 8:41 – 8:50 8:51 – 9:00 9:01 – 9:10 9:11 – 9:20 9:21 - 9:30 9:31-9:40 9:41-9:50

1. 2.

9:51 - 10:10 10:10 - 10:30

Questions and Answers session
CLOSING OF SESSION BY THE CHAIRMAN TEA BRAKE & POSTER PRESENTATION (11:00 am - 11:30 am)

10:30 - 10:40

SECOND SESSION (11:30 am - 2:30 pm)
Chairman Co-Chairman Secretary S# 1. 2. 3. 4. 5. 6. 7. 8. 1. 2. PROF. S. HAROON AHMED PROF. IRSHAD QAZI AND CDR. FARRUKH HAYAT DR. ZAFFAR HAIDER FREE PAPER (10 minutes each) Name of Presenter TOPIC Dr. Saima Qureshi Assessment of sexual dysfunction in female psychiatric patients using antidepressants Dr. Rozeena Dharwarwala Pattern of comorbid substance use among female psychiatric patients Dr. Aisha Yousuf Depression & its associated risk factors in medical & surgical postgraduate trainees Dr. Washdev Sociodemographic profile of substance users attending psychiatry department Dr. Niloufer Sultan Ali Effectiveness of councelling for anxiety and depression Dr. Marriam Shaheen Self medication among males and females in Karachi Dr.Shakila Atif Deliberate self harm-Gender based analysis in terms of age, intent and motivation Dr.Daulat Ram Insomnia in medical students of medical college INVITED TALK (20 minutes each) Prof. Musarrat Hussain Psychiatry; yesterday, today and tomorrow Dr. Muhammad Wasay Burden of neurological diseases Questions and Answers session CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS

Time 12:00 – 12:10 12:11 – 12:20 12:21 – 12:30 12:31 – 12:40 12:41 – 12:50 12:51-13:00 13:01-13:10 13:11-13:20 13:20 – 13:40 13:41 – 14:00 14:01 – 14:10

ORGANIZING COMITTEE:
PROF. SHAUKAT ALI PROF. SATTAR HASHIM PROF. M. IQBAL AFRIDI DR. NAJMUS SAQIB DR ANWAR TANOLI DR ASGHAR DR YAHYA DR ASMA DR SADAF DR MOAZAMA DR ZOHRA NIAZI DR SHAKILA
COURTESY:

DR KHALID SHER DR SAFDAR

SCIENTIFIC SESSION: DENTISTRY, ORAL DISEASES & MAXILLO-FACIAL SURGERY
FRIDAY 19TH FEBRUARY 2010 - TIME:9:00 AM TO 4:00 PM VENUE: LIBRARY BUILDING HALL
JURY MEMBERS FOR BEST PAPER PROF. MERVYN HUSSAIN PROF. NAVEED RASHEED PROF. MOHSIN GIRACH PROF. SAQIB RASHEED JURY MEMBERS FOR BEST POSTER PROF. REHANA MAHER DR. MOHAMMAD ALTAMASH DR. INAYAT PADHIAR DR. SHAKIR MIRZA

FIRST SESSION (9:00 am - 12:00 am)
Chairman Co-Chairman Secretary Moderator By Dr. Abid Mehmood By Dr. Waseem Mushtaq By Dr. Amna Rehman S#
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

PROF. MOHAMMAD ANSAAR KHAN PROF. ABDUL QADIR KHERO PROF. ABDUL HAKEEM ARAIN DR. ABID MEHMOOD Beginning with the name of ALLAH Recitation from Holy Quran and Translation Prayer and Pledge

FREE PAPER (10 minutes each)
Name of Presenter
Dr Rashna Firoze Aga, Dr.Mubassar Fida Dr.Talha Bin Aslam Dr. Farhana Ghaffar, Mubassar Fida Dr.Jehan Alam Dr. Sarwat Memon, Dr.Mubassar Fida Dr. Muhammad Haseeb, Kamran Ali, Faisal Munir Dr. Zubair Ahmad Abbasi Dr. Maryam Riaz Dr. Syed Hammad Ahsan Dr. Ashar Hussain

TOPIC
Dental age table for orthodontic patients at the AKUH Karachi. Lefort I down osteotomy for chondroma,a cranial base tumor Effect of extraction of first four premolars on smile aesthetics after orthodontic treatment. Comparison of cryosurgery and peripheral neurectomy in the treatment of trigeminal neuralgia. Applicability of three mixed dentition analysis methods in orthodontic patients at AKUH Causes of tooth extraction at a tertiary care centre in Pakistan Surgical approach in oral submucous fibrosis Radiographic interpretation Determination of efficacy of anti-plaque agent : A clinical trial Triditional prosthodontic improves aesthetics and hand function

Time 9:00 - 9:10 9:10 - 9:20 9:20 - 9:30 9:30 - 9:40 9:40 - 9:50 9:50 - 10:00 10:00 10:10 10:20 10:30 10:10 10:20 10:30 10:40

CLOSING OF SESSION BY THE CHAIRMAN TEA & PRAYER BREAK & POSTER PRESENTATION (12:30 PM – 03:00 PM) SECOND SESSION (03:00 PM – 5:30 PM)
Chairman Co-Chairman Secretary Moderator S#
1. 2. 3.

PROF. MUSHTAQ AHMED MEMON PROF. ABDUR RAUF MEMON PROF. ZIA ABBAS DR. ABID MEHMOOD

INVITED TALKS (20 minutes each)
Name of Presenter TOPIC Time
3:00-3:20 3:21-3:40 3:41-4:00 3:41-4:00 Dr. Fawad Javed Oral inflammatory condition and diabetes mellitus Dr. Mehmood Hussain Prosthodontics rehabilitation of diabetic patients. Dr. Mohammad Mujahid Khan Maxillary artery perforating inferior alveolar nerve Questions and Answers session

Workshop (Hands on) DENTAL IMPLANTS, A to Z by Mr. Mohammad Shamim CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS / TEA BREAK BREAK FOR MAGHRIB PRAYERS Organizing Committee: DR. ABID MEHMOOD DR. AMNA REHMAN DR. ARIFA AFZAL DR. SANA SALEEM DR. INDRA RAJWANI DR. REETA SUKHARANI DR. HASSAN FURQAN DR. WAJIHA ZAHID DR. JAHAN ALAM DR. HARESH KUMAR DR. MUSTAFA KAMAL DR. SHAHRYAR KHAN DR. RAKHI DR. HIRA MIRZA DR. M. KASHIF RAIZ DR. SANA BATOOL NAQVI DR. FATIMA DR. AHSAN ALI DR. ASHA DEVI DR. MEHWISH DR. SAFA DR. AFSHAN HIDAYAT DR. NATASHA SAEED
COURTESY:

Platinum

Scientific Session: ORTHOPEDIC & TRAUMA (Reconstruction, Hand, Micro-Surgery, Paeds Orthopedics)
SATURDAY 20TH FEBRUARY 2010 / TIME: 8:00 AM TO 2:30 PM VENUE: JPMC NAJMUDDIN AUDITORIUM - MAIN HALL
JURY MEMBERS FOR BEST PAPER JURY MEMBERS FOR BEST POSTER Prof. Sulaiman A. Khan Prof. M. Idrees Prof. I. A. Jokhio Prof. Anis Bhatti Prof. Ghulam Mehboob Prof. Mujahid Humail FIRST SESSION (8:00 AM – 11:00 AM)
Chairman Co-Chairman Secretary Moderator S# 1. 2. 3. 4. 5. 6. Prof. Muhammad Idrees Prof. Shahid Ilyas Dr. A. R. Jamali Dr. Irfanullah Ansari

FREE PAPER (10 minutes each)
Name of Presenter Suresh Kumar, AR Jamali, Azad Shaikh, Functional outcome of olecranon osteotomy for fixation of Anisuddin Bhatti, JPMC t-y fractures distal humerus Shahryar Noorddin AKUH Pelvic dissociation in revision total hip arthroplasty: Diagnosis and treatment. Siraj Ahmed But, A.R. Jamali, Outcome of treatment of not united femoral neck fractures Azad Shaikh, Anisuddin Bhatti, JPMC in adults with free fibular graft S. Kamran Ahmed, Indus Hospital Paired Abdominal Flap, A reliable hand sandwich for hand injuries Hasnain Raza, Haroon-ur-Rashid, Outcome of hip reconstruction Osteotomy Masood Umer AKUH Kashif Abbas and Ligament reconstruction with tendent interposition for Pervaiz Hashmi carpometacarpal joint arthritis Time 8:30 –8:40 8:40 –8:50 8:50 –9:00 9:00 – 9:10 9:10 – 9:20 9:20 – 9:30

INVITED TALK (20 minutes each)
1. 2. 3. 4. 5. Prof. Zaki Idress (LNH) Dr. M. Amin Chinoy (Indus Hospital) Dr. Intikhab Taufiq (LNH) Dr. Syed Shahid Noor (LNH) Dr. Masood Umer (AKU) Q&A Session Orthopedic Training: A National Perspective Metal on metal large ball arthroplasty in Pakistan Early Mobilization After Pelvic fracture Fixation THR: Choice of head size bearing Surface & method Limb salvage vs amputations in musculoskeletal tumor surgery Participant VS Panel of Experts 9:30 – 9:50 9:50 – 10:10 10:10—10:30 10:30—10:50 10:50—11:00 At Tea time

CLOSING OF SESSION BY THE CHAIRMAN TEA BREAK & Poster Presentation (11:20 AM – 11:40 AM)

Chairman Co-Chairman Secretary Moderator 1. 2. 3. 4. 5. 6.

SECOND SESSION: Seminar ; LEVELS OF AMPUTATIONS (11:30 AM – 2:30 PM) Prof. I A Jokhio Prof. Zaki Idress Prof. Ghulam Mehboob Dr. Azad Sheikh

INVITED TALK (20 minutes each)
Prof. Anisuddin Bhatti (JPMC) Prof Syed Muhammad Munir (JPMC) Prof. Mujahid Humail (DUHS) Prof. Abdul Moeed Kazi (Z.U.H) Prof. Ghulam Mehboob (JPMC) Prof. Nabila Soomro (DIPMR) Q&A Session Diabetic Foot Ulcers: Patho-physiology Practical guidelines on the management and prevention of diabetic foot Diabetic foot amputations: can we prevent that Level of amputations: an over view Level of amputations: ideal stump formation Levels of amputations: pit falls & problems Participants vs panel of experts 11:40 – 12:00 12:00 – 12:20 12:20 – 12:40 12:40 – 13:00 13:00 – 13:20 13:20 – 13:40 13:40 – 14:00

CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS ORGANIZING COMITTEE:
Prof. Anis Bhatti Dr. A. R. Jamali Dr. M. Saeed Minhas Dr. Nasir Baig Dr. Saeed Dr. Amara Saeed Dr. Mujeeb Ur Rehman Dr. Kashif Mehmood Dr. Qasim Mr. Saeed Kashif Dr. Suresh Dr. Irfanullah Ansari Dr. Khurram Shahzad Mr. Sajid
COURTESY:

Dr. Muhammad Sulaiman Dr. Azad. A Shaikh Dr. Barkatullah Dr. Badruddin Dr. Ghulam Mehboob

SCIENTIFIC SESSION: RADIOTHERAPY/ONCOLOGY
SATURDAY 20TH FEBRUARY 2010 TIMINGS: 11:00 AM TO 2:00 AM VENUE: CANCER OPD HALL
JURY MEMBERS FOR BEST PAPER AND POSTER: Prof. S.H.M Zaidi Dr. Azmeena Vali Muhammad Dr. Salman Adil

SESSION :11:00 AM – 2:00 PM
Chairman Co-Chairman Secretary Moderator
S#

Prof. S.H.M. Zaidi Prof. Ahmed Usman Dr. Heeranand Dr. Maryam Gul

INVITED TALK (20-25 minutes each)
Name of Presenter TOPIC Time

1. 2. 3.

Dr. Azmeena Vali Muhammad (AKUH) Management of locally advanced breast ca Dr. Salman Adil (AKUH) Diagnosis & management of acute leukemia Dr. Nehal Masood (AKUH) An update on treatment of non- small cell lung cancer Q&A Session

11: 00 -11:25 11:26 – 11:50 11:51 – 12:15 12:15 – 12:39

FREE PAPER (10 minutes each)
1. 2.
3.

Dr. Heeranand (JPMC) Dr. Mutahir A .Tunio (SIUT) Dr.Mansoor Rafi (SIUT)

4. 5. 6.

Mr. Asad Zameer (SIUT) Dr. Noor M. Soomro (CHK) Dr. Rafia Toor (SIUT) Dr. Amir Maqbool (KIRAN) Dr. Ahmed Mateen (KIRAN)

7. 8.

Safety and tolerability of folfox,4 in the adjuvant treatment 12:40 – 12:50 of colon cancer in our population Neoadjuant cisplatinum and gemcitabine based 12:51 – 13:00 chemotherapy followed by concurrent chemo-radiation for muscle invasive bladder cancer Comparison of three methods for skin markings in 13:01-13:10 conformal radiotherapy, temporary markers and permanent steritatt civco® tattooing: patients’ comfort and radiographers’ satisfaction Role of medical physicist in radiation oncology 13:11- 13:20 Breast cancer history to, today 13:21- 13:30 Hypofractionated schedule of palliative radiotherapy in 13:31- 13:40 the management of gross haematuria of invasive bladder cancer patients. Concurrent cisplatin based chemo-radiation for locally 13:41 – 13:50 advanced head and neck cancers- experience at kiran. Risk stratification in breast cancer; retrospective analysis 13:51 – 14:00 at KIRAN

CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS ORGANIZING COMMITTEE:
Prof. Ahmed Usman Dr.Heeranand Dr. Ghulam Haider Dr. Aneeta G. Mohammad Dr. Tahseen Khursheed Dr. Maryam Gul Dr. Khalil Ahmed
COURTESY:

Dr. Abdul Sami Mr. Mussarat Abbas Mr. Murtaza Haider

Dabur Oncology

SCIENTIFIC SESSION: ANAESTHESIA, SURGICAL ICU & PAIN MANAGEMENT
SATURDAY 20TH FEBRUARY 2010 / TIME: 09:00 AM TO 01:00 PM VENUE: NAJMUDDIN AUDITORIUM HALL-A
JURY MEMBERS FOR BEST POSTER Prof. S. Tipu Sultan Prof. Rehana Kamal Prof. Akhtar Waheed Khan

INVITED TALK (20-25 minutes each)
S# 1. 2. 3. 4. 5. Name of Presenter Prof. Nasir Khan Jakhrani (JPMC) Prof. Younis Khatri (ZMU) Dr. Akhtar Aziz (Indus Hospital) Prof.Saeeda Haider (CHK) Prof.Fazal Hameed Khan (AKUH) TOPIC Are we ready to manage bomb blast injuries in our city?? —An Overview Optimizing poly trauma patient at the site of bomb blast Transfer of patient from the site of bomb blast to the Hospital Managing major haemorrhage in poly trauma Battle Field Anaesthesia

TEA BREAK : 11:15 - 11:40 am
6. 7. 8. Brigadier Asif Gul Kayani (CMH, Bhawalpur) Brigadier M.Saleem (RH-Rawalpindi) Prof. Qamar-ul-Hoda (AKUH) Prof. Najma Amjad (NICVD) Challenges faced by the anaesthetic team in poly trauma due to bomb blast Management of pain due to poly trauma in bomb blast Anaesthetist’s contribution to the management of burns due to bomb blast Anaesthetic management of cardio thoracic injuries due to bomb blast

9.

CLSOING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS ORGANIZING COMMITTEE:
DR. ROOHINA BALOCH DR. ERUM ZEB DR. NADEEM MUNIR DR. A. RAHIM MEMON DR. ZULFIQAR ALI DR. NAEEM KHAN DR. NAZEER AHMED DR. UMAR FAROOQ DR. SHOAIB MALIK DR. NIGHAT YASMIN DR. SHEHNEELA RAZA DR. KASHIF MAHMOOD DR. AYAZ SARWAR DR. FAUZIA ALI DR. AMANULLAH MEMON DR. TAHIR A. CHAUDHRY DR. KHALID CHOHAN
COURTESY:

SCIENTIFIC SESSION: ULTRASOUND COLOR DOPPLER
SUNDAY 21ST FEBRUARY 2010 - TIMING: 8:00 AM TO 02:30 PM VENUE: NAJMUDDIN AUDITORIUM MAIN HALL
JURY MEMBERS FOR BEST PAPER PROF. SHABBIR A NAEEM (SIUT) DR. ANWAR AHMED (ZUH) DR. MUKHTAR A MEMON (CHK)
FIRST SESSION (8:00 AM – 11:00 AM)
Chairman Co-Chairperson Secretary Moderator S# 1. 2. 3. 4. 5. 6. DR. MOHAMMAD NAFEES (ARC) DR. IMRANA MASROOR (AKUH) DR. FAYYAZ AHMED (JPMC) DR. SAIRA MANSUR (JPMC)

FREE PAPER (10 minutes each)
Name of Presenter TOPIC DR. NURUDDIN MOHAMMED Uterine artery Doppler screening in the second trimester for prediction of (AKUH) adverse pregnancy outcome in high risk Pakistani women. DR. FARHEEN IMTIAZ Role of grey scale & Doppler u/s in the diagnosis of painless scrotal masses in patients. DR. VAQAR BARI (AKUH) Role of abdominal U/S in trauma patients. DR. SAIRA NAZ (LNH) Diagnosis in staging of ovarian cancer comparative study between U/S and CT correlated with surgery. DR. RUBINA ASHRAF (LNH) Comparison of CT and U/S in the diagnosis of acute appendicitis. DR. ADNAN HASHMI (KIRAN) Frequency of penile arterial insufficiency and venous leakage in patients having erectile dysfunctional by color Doppler U/S. Time 8:30 – 8:40 8:41 – 8:50 8:51 – 9:00 9:01 – 9:10 9:11 – 9:20 9:21- 9:30

INVITED TALK (25-30 minutes each)
1. 2. DR. NADEEM AHMED (AKUH) Carotid Doppler. DR. FURQAN AHMED (SCH) Role of endoscopic ultrasound in meditational lymphadenopathy. Q&A Session 9:31 – 10:00 10:01– 10:30 10:31 – 11:00

CLOSING OF SESSION BY THE CHAIRMAN TEA BREAK & Poster Presentation (11:00 AM – 11:30 AM) SECOND SESSION (11:30 AM – 2:30 PM)
Chairperson Co-Chairman Secretary Moderator S# 1. 2. 3. 4. 5. DR. DR. DR. DR. TANVEER ZUBERI (TUC) SALEEM KHEMANI (ZMU) MUSSART HASAN (DU) NAYYER NAWAZ ( JPMC)

INVITED TALK (25-30 minutes each)
Name of Presenter DR. NADEEM ABBASI (AKUH) PROF. TAMEEM AKHTAR (ZHU) DR. AMJAD SATTAR (SIUT) DR. AMBER PARAS (JPMC) DR. NAILA NADEEM (AKUH) TOPIC Radiologist – An important team player in cancer management. U/S of fetal anomalies. U/S of prostate. Characterization of bowel pathologies on U/S. Role of musculoskeletal U/S in pediatrics. Q&A Session Time 11:40 - 12:00 12:01 - 12:30 12:31 - 13:00 13:01 - 13:30 13:31 - 14:00 14:01 - 14:10

CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF MEDALS & MOMENTOS Organizing Committee:
PROF. TARIQ MAHMOOD DR. KAUSAR SALDERA DR. RUBINA ISHTIAQUE DR. SHAGUFTA NAZ DR. NIRMAL DR. SAIRA MANSOOR DR. NOMITA IRFAN DR. AYESHA MUGHAL DR. BUSHRA AYUB DR. NAUMAN IRSHAD DR. TASNEEM BUTT DR. IRAM RAZA DR. MANSOOR ALI DR. NAILA KAMRAN DR. NADIA MALIK DR. NAJAMULHASSAN DR. AKHTAR ABBAS DR. NISAR AHMAD DR. WARYAL MEMON DR. GHANSHAM DR. RAZA YOUNUS MR. IQRAR ALI MR. ZAHEER AHMED MR. MOOSA JAN MR. JUNAID A. KHAN

COURTESY:

SCIENTIFIC SESSION: CT & MRI
SUNDAY, 21ST FEBRUARY 2010 - TIME: 8:00 AM TO 2:30 PM VENUE: J.P.M.C. NAJMUDDIN AUDITORIUM-HALL A
JURY MEMBERS FOR BEST PAPER BRIGD. IRFAN UL HAQ DR. MAHIRA YUNUS DR. WASIM AKHTAR
Chairman Co-Chairman Secretary Moderator S# 1. 2. 3. 4.

JURYMEMBERS FOR BEST POSTER DR. SYED MAHMOOD DR. RASHID AHMED DR. WASIM MEMON

FIRST SESSION (8:00 AM – 11:00 AM)
PROF. MUMTAZ MAHER - JPMC DR. AYUB MANSOOR - LNH DR. JAWAID MAHBOOB - KIRAN DR. AMARA SAEED – JPMC

FREE PAPER (10 minutes each)
Name of Presenter DR. MAHIRA YUNUS (SIUT) DR. MUNAZZA SALEEN BAIG (AKUH) DR. KAUSAR ILLAHI BUX (JPMC) MS. SHAHEEN DHANANI (AKUH) BRIG. MOHAMMAD ILYAS DR. TANVEER UL HAQ TOPIC Ct guided lung abscess drainage Megnetic resonance arthrogram: a screening test to diagnose shoulder joint instability Mdct assessment of acetabular fracture: a comparison between modified reconstruction images and 3d images Awareness of radiation protection in clinical and non-clinical staff Role of CT in acute abdomen Role of radiology in management of CLD Q&A Session Time 8:30 – 8:40 8:41 – 8:50 8:51 – 9:00 9:01 – 9:10

INVITED TALK (25-30 minutes each)
1. 2. 09:30 – 10:00 10:00 – 10:30 10:30 – 10:40

CLOSING OF SESSION BY THE CHAIRMAN TEA BREAK & Poster Presentation (11:00 AM – 11:30 AM) SECOND SESSION (11:30 AM – 2:30 PM)
Chairman Co-Chairperson Secretary Moderator S# 1. 2. 3. 4. 5. DR. DR. DR. DR. MUHAMMAD AZEEMUDDIN – AKUH SABA SOHAIL – CHK AMIR BHATTI – NMC AMARA SAEED- JPMC

FREE PAPER (10 minutes each)
Name of Presenter DR. IMRANA MASROOR (AKUH) DR. SADAF NASIR (LNH) DR. SHAISTA SHAUKAT (JPMC) DR. MAHREEN RASOOL (JPMC) MR. ZAFAR JAMIL (AKUH) TOPIC To determine the sensitivity of dwi in detection of endometrial carcinoma (case control study): role of adc values Flexion / extension cervical spine views in blunt cervical trauma Additive value of susceptibility weighting imaging in neuroradiology Mri imaging in the evaluation of medically intractable epilepsy Heart: what can be seen on non coronary thoracic multi detector computed tomography scan? Time 11:40 - 12:00 12:11 – 12:20 12:21 – 12:30 12:31 – 12:40 12:41 – 12:50

INVITED TALK (25-30 minutes each)
1. 2. DR. ZIA FARUQUI

DR. ZAFAR SAJJAD

Principles of staging in lung cancer Megnetic resonance evaluation of white matter Q&A Session

13:00 – 13:30 13:31 – 14:00 13:31 – 14:00

CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS Organizing Committee:
Dr. Zafar Sajjad Dr. Saima Imran Dr. Muhammad Salman Dr. Nadira Abid Dr. Champa Rani Dr. Amber Paras Dr Rajni Dr. Sohail Ahmad Dr. Kashif Mughal Dr. Sadaf Rizvi Dr. Mahreen Rasool Dr. Kavita Dr. Darshan Lal Dr. Rani Benish Dr. Madiha Asad Dr. Sadaf Imran Dr. Inayatullah Dr. M. Farhan Baig

COURTESY:

SCIENTIFIC SESSION: RADIOISOTOPE AND DEXA SCAN
SUNDAY 21ST FEBRUARY 2010 - TIME: 8:00 AM TO 11:30 AM VENUE: NAJMUDDIN AUDITORIUM MAIN HALL B
JURY MEMBERS FOR BEST PAPER AND POSTER Dr. SHAHID KAMAL Dr. AKHTER AHMED Dr. HASSAN RAZA

SCIENTIFIC SESSION (8:00 AM – 11:00 AM)
Chairman Co-Chairman Secretary Moderator Prof. S.H.M. Zaidi – BMU Dr. Abid Hameed – KIRAN Dr. Akhter Ahmed – KIRAN Dr. Zafar Nasir – AEMC, JPMC

FREE PAPER (10 minutes each)
S# Name of Presenter 1. Dr. Bashir Ahmed 2. Dr. Sajid Sattar 3. 4. 5. 6. 7. 8. Dr. Zafar Nasir Dr. Maseeh uz Zaman Dr. Nosheen Fatima Dr. M. Obaid Arif Dr. Kashif Niyaz Dr. Naureen Nizar TOPIC Attenuation correction in Myocardial perfusion SPECT imaging LV EF derived by ECG gated SPECT vs angiography determination in suspected or known CAD. Utility of combined MIBI & bone scan in solitary musculoskeletal pathology Prevalence of positive gated myocardial SPECT in diabetic & non-diabetic women & impact of other risk factors; KIHD Predictive value of pathological Q-waves for fixed perfusion defect & its impact on LV function by gated SPECT. Detection of CAD in hypertensive patients by exercise stress MPI using Tc-99m MIBI Role of split dose bone scanning for the assessment of skeletal metastasis in patients with malignancy Role of Tc-99m MAG3 scintigraphy in management of nonfunctioning kidney on IVU Time 8:20 – 8:30 8:31 – 8:40 8:41 – 8:50 8:51 – 9:00 9:01 – 9:10 9:11 – 9:20 9:21 – 9:30 9:31 – 9:40

INVITED TALK (20-30 minutes each)
1. 2. Dr. Zia Faruqui Dr. Maseeh uz Zaman PET/CT Recent development & future prospect of SPECT Myocardial Perfusion Imaging Question and Answer 09:50 – 10:20 10:20 - 10:40

CLOSING OF SESSION BY THE CHAIRMAN REFRESHMENTS (11:00 AM – 11:30 AM) Organizing Committee:
Dr. Akhter Ahmed Dr. Zafar Nasir Dr. Muhammad Ejaz Dr. Raheela Mehmood Dr. Minhaj Maqbool

COURTESY:

Abstracts

PREVALENCE OF SUB-TYPES AND SEVERITY OF RED-GREEN COLOR VISION DEFICIENCY IN MEDICAL STUDENTS OF KARACHI
FAIZ-UR-REHMAN FAROOQUI1, GUL AFSHAN2, SHAHZAIB PERVEZ3, ERUM IMRAN5, NAVEED AHMED6, NARGIS ANJUM4 1Dept. of Medicine, Karachi Medical & Dental College, and Abbasi Shaheed Hospital, Karachi, 2,4,5Dept. of Physiology, Karachi Medical & Dental College, and Abbasi Shaheed Hospital, Karachi, 3Fourth Year & 6Second Year Medical Students, Karachi Medical & Dental College, Karachi AIMS AND OBJECTIVES: The study aims to find out the prevalence of subtypes and severity of red-green color vision deficiency in medical students of Karachi. MATERIAL & METHODS: It was a cross sectional study conducted on the students of Karachi Medical & Dental College and Dow University of Health Sciences. With Convenient sampling, 550 healthy medical students (185 males and 365 females) were tested by using pseudo-isochromatic plates of 24-plates Ishihara chart. The data is presented in the form of numbers and percentages. RESULTS: 10 (5.4%) out of 185 males while only 01 (0.26%) out of 365 females were found to have red-green color vision deficiency. In males, 03 (1.62%) were Protans and 07 (3.78%) were Deutans. Protanomaly was detected in 01 (0.54%), protanopia in 02 (1.08%), deuteranomaly in 02 (1.08%), deuteranopia in 05 (2.70%). In females, the only case found was deuteranopia, 01 (0.26%). CONCLUSION: By conducting screening for all medical students for diagnosing and detecting the sub-types and severity of CVD and provision of adaptive strategies and behavioral support will help them to deal with the potential difficulties, which could be overcome by awareness, self-training and effort. Moreover it is strictly advisable to avoid certain subspecialties as a career of choice. KEY WORDS: Congenital color vision deficiency, Red-green CVD, Protan, Deutan, Ishihara charts.

The services can be better utilized or improved by 1. 2. 3. Proper & timely referral of cases Proper selection of cases Updating / modifications in treatment protocols

CORNEAL ENDOTHELIAL CELL DENSITY IN OPEN ANGLE GLAUCOMA PATIENTS USING SPECULAR MICROSCOPY
DR.SAIMA MAJID, DR.ALYSCIA M.CHEEMA, DR.VASDEV HIRANI, DR.JAVED HASSAN NIAZI Department of Ophthalmology Jinnah Postgraduate Medical Centre, Karachi OBJECTIVES: To study corneal endothelial cell density in open angle glaucoma patients using specular microscopy. MATERIAL AND METHODS: Study Setting: Department of Ophthalmology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan Study Duration: Six months. Study Design: Retrospective study of patients registered in glaucoma clinic within 6 months. SAMPLE SELECTION: Inclusion Criteria: Open angle glaucoma patients. Either sex No co-morbid. Exclusion Criteria: History of trauma. Corneal disease Ocular inflammation. DATA COLLECTION PROCEDURE: Data were entered from patient’s files in glaucoma clinic i.e. were glaucoma types, duration, laser treatment, glaucoma medication, documented intraocular pressure measurements. Specular microscopy was performed on central cornea, endothelial margins were analyzed by computerized perimetry and cell counts were calculated.

BETA RADIATION THERAPY FOR APPROPRIATE OCULAR LESIONS
*DR. MUHAMMAD ALI MEMON, KHALID MEHBOOB, DR. SHAHID KAMAL, SALMAN FURRUKH**, MUNIB AHMED*** *Clinical Oncologist / DCMO, Health Physicist**, Medical Physicist*** Atomic Energy Medical Centre Jinnah Postgraduate Medical Centre, Karachi OBJECTIVE: To share & update the experience. INTRODUCTION: Beta Radiation therapy is a unique form of treatment modality for superficial lesions. Radiosensitive Conjuctival lesions i.e. Pterygium & Conjuctival Carcinoma are difficult to treat on conventional Megavoltage External Beam RadioTherapy (EBRT) due to very delicate & sensitive structures in the vicinity of conjuctiva. Strontium-90 is essentially a beta ray emitter and most suitable for such lesions. MATERIAL & METHOD: This is a retrospective analysis of 23 patients treated during 1995 to 2003 at NIMRA Jamshoro. Male were 18 & female 5. Age ranges from 20-85 years with mean 44.3 & median 45. Pterygium was the most common lesion i.e. seen in 11 patients treated. Surgical attempts i.e. excisions were 50 in 21 patients. Beta radiation therapy was given to 23 patients. External beam therapy for two patients and Chemotherapy for 1 patient was also given during course of treatment for residual / progressive disease. Follow-up ranges from 02 to 156 weeks with median follow up of 06 weeks. Being a referral institute, most cases were referred back to referring surgeon. However in evaluated patients, 10 were disease free on last visit, 2 left treatments incompleted, 2 had progressive disease. 9 had no follow-up. An experience of 11 patients with conjuctival lesions treated with beta radiation at AEMC, JPMC, Karachi will also be shared. REMARKS / COMMENTS: Available costly but cost effective facility is under utilized due to lack of co-ordination between concerned departments. Monotony of treatment protocols over a long period of time has now standardized as per current schedules in practice.

OUTCOME OF EXTERNAL DACRYOCYSTORHINOSTOMY FOR ACQUIRED NASOLACRIMAL DUCT OBSTRUCTION AT FOUR MONTHS FOLLOW UP
DR. ATIQ UR REHMAN, DR MUHAMMAD ALI TAHIR, DR ALYSCIA MIRIAM CHEEMA, DR VASDEV HARANI, DR JAVED HASAN NIAZI Department of Ophthalmology Jinnah Postgraduate Medical Centre, Karachi OBJECTIVE: To determine the success of dacryocystorhinostomy in patients with pre sac and post sac obstruction at four months follow up. METHODS: It is an ongoing study of so far 23 dacryocystorhinostomies with silicone intubation performed for partial nasolacrimal obstruction.pre operative syringing and probing was done to see obstruction in all cases and lacrimal scintigraphy will be done to see pre sac and post sac delays.post operative success was determined by lacrimal patency to irrigation and subjective resolution of epiphora. RESULT: A patent DCR system was achieved in 88% of patients. CONCLUSION: External dacryocystorhinostomy with silicone intubation is an effective procedure for partial nasolacrimal obstruction.

OCCUPATIONAL EXPOSURE TO NEEDLE STICK INJURIES AND THEIR ASSOCIATED FACTORS AMONG HEALTH CARE WORKERS IN A DEVELOPING COUNTRY
1AMEET

KUMAR LOHANA; 2ALI KHAN KHUWAJA; ASAD AFRIDI; MUHAMMAD QASIM MEMON 1House Officer, Jinnah Postgraduate Medical Centre, Karachi 2Assistant Professor and Convener Research, Family Medicine, Aga Khan University, Karachi INTRODUCTION: The health care workers (HCWs) are at substantial risk of acquiring blood borne infections such as HIV, Hepatitis-B and Hepatitis-C through needle stick injuries (NSIs). This study was aimed to assess the proportion of NSIs and their associated factors among HCWs and also to identify the areas in which preventive efforts might be directed to protect against this occupational hazard. METHODS: A cross-sectional study was conducted in two tertiary care hospitals of Pakistan representing both private and public health sector. During the months of January to May, 2008, trained medical graduates interviewed 497 HCWs (Doctors and Nurses) who were working in those particular hospitals for > one year and willing to participate in the study. RESULTS: Overall, 63.6% of the HCWs were exposed to at least one NSI during his/ her carrier; among them 73.4% reported NSIs for two or more times. Factors found to be highly associated with NSIs were those practicing this occupation for > five years (p < 0.001: OR = 5.8; 95% CI = 3.4 - 9.8) and working as Nurse than Doctor (p < 0.001: OR = 1.9; 95% CI = 1.3-2.8). Working in surgical specialty and being a female were also found to be associated with NSIs (p < 0.05). Most commonly (54.7%) reported reason for NSIs was two-handed recapping of needle. Only, 35% of study subjects were vaccinated for hepatitis B infection. Overall, only 39.8%, 40.2%, 10.7%, 25.8% and 9.9% of study participants reported to have availability of anti-septic solutions, gloves/protective cloths, sharp/disposable containers, trays/syringe containers and infection control guidelines/protocols respectively in their working places. DISCUSSION: In addition to very high rates of NSIs, low safety practices including vaccination coverage, unavailability of infection control guidelines and other preventive facilities were reported in this study. Prevention of occupational infections among HCWs should be a priority. Training about safe practice and availability of preventive facilities should be ensured against NSIs among HCWs. KEY WORDS: Health care workers; Needle stick injuries; Occupational exposure

THE ANALYSIS OF ACUTE POISONING CASES DURING FOUR YEARS PERIOD (2005-2008) IN NATIONAL POISON CONTROL CENTER IN WARD-V, JINNAH POSTGRADUATE MEDICAL CENTER, KARACHI
JAMAL ARA, RUBABA KHAN Medical Unit-I, Ward 5 Jinnah Postgraduate Medical Centre, Karachi OBJECTIVES: The aim of the presented study was to determine the trends and characteristics of acute poisonings in national poison control center, ward-V JPMC including the rate, type, and causal agents over a period of four years (2005-2008). MATERIALS AND METHODS: The analysis was based on the data obtained from the patients' records register of ward-v maintained during 2005-2008. DURATION OF STUDY: Two months. RESULTS: There were a total of 6827 admissions with acute poisoning in four years and out of these organophosphorus contributed the largest chunk (32%), second was drugs (15.14%) including benzodiazepine, anti-psychotics, Nsaids etc, third most common was unknown (13.54%). Venoumous animals, heroin addicts , alcohol, petrol/kerosene, bleach, acid, dhatura, rat killer, anti-lice and metals contributed 11.0%, 5.81%, 1.94%, 1.61%, 4.67%, 3.04%, 1.53%, 4.55%, 2.81% and 2.27% respectively. Organophosphorus was found fatal in majority of cases (36.74%), unknown second most common (14.91%) followed by heroin (13.53%). DISCUSSION: Studies in Poland1-2 by Czerczaks et al and Kotwica M et al; have shown alcohol and drugs with most lethal outcome. While studies in India3, Japan4 and Punjab 5-6(Pakistan) have found pesticides the most lethal agent. Our study revealed a striking preponderance of intoxication with organophosphorus compounds which is comparable to national and international studies. This studies also supports organophosphorus being the most used and lethal agent most probably due to its easy availability being an agriculture country, effectiveness and low cost. CONCLUSIONS: A constantly growing number of acute poisonings in ward-v national poison center, JPMC Karachi makes it necessary for all the medical and other professionals involved (clinical toxicologists and diagnostic laboratory staff) to enhance and coordinate their efforts. These activities should be focused on (a) selection of the most effective methods to eliminate poisons from the system and improve further therapy, and (b) prompt availability of antidotes (c) psychiatric care for people must be recommended by all physicians suffering from mental problems or depression and for the unsuccessful or potential suicide. RECOMMENDATIONS: Studies, which unveil the root causes of growing and constant increase in poisoning, are needed. Awareness of harmful effects of all poisonous agents might help to avoid accidental poisoning. Poverty elimination and education need special attention.

DEPRESSION IN DIABETICS
*DR. FIRDOUS JAHAN, DR. ABDUL JABBAR, DR. HAIDER NAQVI, DR.SAFIA AWAN *Assistant Professor, Department of Family Medicine Aga Khan University Hospital, Karachi {Email: } OBJECTIVES: Depression in patients with diabetes mellitus and its Relationship with diabetes self-care, medication adherence and glycemic control. BACKGROUND: The prevalence of diabetes is growing significantly. The World Health Organization estimates that at least 170 million individuals suffer from diabetes globally, this figure is likely to double by 2030. Depression is an independent risk factor for the onset of type 2 diabetes. It negatively affects the course of diabetes and is associated with increased risk of complications (especially heart disease), hyperglycemia, and mortality. METHOD: Cross sectional study done in ambulatory care . Three hundred forty diabetic patients were screened for depression and clinical characteristics of complication. All analyses was done by using the Statistical package for social science SPSS. RESULT: A total of 320 patients with Diabetes were identified during the study period. The mean age was 55±12 years and 138 (43%) were females. Hypertension 197(61.6%) and IHD 68(21.3%) were the most common co-morbids. Overall, 283(88.4%) received oral agents, and 134(41.9%) received insulin alone. Depression was present among 17% of patients with diabetes and was more common in 158(86.8%) male than females 106(76.8%) with diabetes (p=0.02), more prevalent among hypertensive 152(77.2%) patients (p=0.001), duration of diabetes >10years (p=0.06), family history of depression (p=0.008). Depression was more prevalent in patients with Neuropathy 126(74.6%) complication (p<0.001). Depression was associated with infrequent fruit and vegetable intake (76% vs. 87%). CONCLUSION: Depressed diabetics had more complications and sub optimal self care. Coexistence of Depression had poor glycemic control.

PATTERN OF PHYSICAL ACTIVITY AND ITS DIFFERENCES AMONG SCHOOL GIRLS AND BOYS IN PAKISTAN
ADEEL AKBAR KHOJA*, KOMAL MOTWANI*, SALEEM KHAWAJA*, ALI KHAN KHUWAJA** *Students, Dow University of Health Sciences, Karachi **Assistant Professor and Convener Research Department of Family Medicine Aga Khan University, Karachi BACKGROUND: Obesity among school going children is one of the major global health challenge. The objectives of this study were to identify the pattern of physical activity and its difference among adolescent girls and boys. METHOD: A cross-sectional, questionnaire based survey was conducted in five inner city secondary schools serving predominantly middle and lower socioeconomic class in Karachi and Quetta. In all, 314 adolescents (13 to 17 years) completely responded to the questionnaire. All the data was collected and managed by trained medical graduates. Chi-square test was used to calculate the differences of physical activity pattern among girls and boys. RESULTS: Questionnaire was administered to 159 boys (50.6%) and 155 girls (49.4%). Large majority (83.7%) of adolescents were using vehicle to and from school and over half (55.1%) of respondents spent three hours and more on watching television, playing computer games or doing other sitting activities. Only 20.1% of adolescents were involved in vigorous activities; more boys compared to girls (34.0% vs. 5.9%; p<0.001). Similarly, boys were found to be more physically active for at least thirty minutes per day as compared to girls (27.7% vs. 16.8%; p=0.01). Less than half of the study participants were taught about physical education and 38.8% of them had accessibility of play ground other than school. CONCLUSION: Substantially large proportion of adolescents particularly girls were physically inactive in this study. There is a need for those with responsibility

for adolescent’s health, including parents, schools, and community health providers, to consider and address the need for effective interventions to encourage increased physical activity level among adolescents. KEYWORDS: Physical activity, Adolescents, Pakistan

one course of conventional interferon 3 million units thrice per week plus ribavirin 800-1200 mg daily for at least 24 weeks were considered eligible for this study. All patients were required to have a liver biopsy that showed findings consistent with a diagnosis of chronic hepatitis C infection according to Batts-Ludwig and Histology Activity index classification. The biopsies were done by trainees under supervision of consultant after taking informed written consent inpatient for 8 hours. Patients had previous course of conventional interferon monotherapy, age below 18 years, concomitant evidence of B or D virus infections, HIV virus infection, decompensated cirrhosis, alcohol or intravenous drug abuse, pregnancy, malignancy, autoimmune disease, hemoglobin , pre-existing psychiatric disease, and seizure disorders were not included. Computer program SPSS version 15 was used to manage and analyze data. RESULTS: Out of 109 patients 57 (52.3%) were female and 52 (47.7%) were male. Mean age 38.9±8.8 years. Among these, 100 (91.7%) patients never achieved undetectable HCV RNA (qualitative PCR testing) during the first treatment nonresponders and 9 (8.3%) patients showed undetectable HCV RNA during the therapy but became HCV RNA positive after discontinuing medication relapsers. Genotype 1 was seen in of 29 (26.6%) patients and 3 in 78 (71.6%) of patients. Genotype of 1 patients was missing and one patient was untypable. Grade 1 inflammation were present in 51 (46.8%), grade 2 in 47 (43.1%), grade 3 in 10 (9.2%) and grade 4 in 1(0.9%) of patients. Stage 0 fibrosis were present in 10 (9.2%), stage 1 in 34 (31.2%), stage 2 in 36 (33.0%), stage 3 in 13 (11.9%) and stage 4 in 16 (14.7%) of patients. CONCLUSION: Majority of nonresponder and relapser patients were female most of them had grade 1 and 2 inflammation with stage 1 and 2 fibrosis. KEY WORDS: Conventional interferon. Nonresponder. Relapser.

THALASSAEMIA PREVENTION PROGRAMME: PLANNING & DEVELOPMENT DEPARTMENT, GOVT. OF SINDH – FATIMID FOUNDATION
DR. AIYESHA HUMAIRA Consultant Haematologist & Director Haemophilia Department Fatimid Foundation, Karachi INTRODUCTION: About 5% of Pakistani population is the carrier of â-thalassaemia and there are 25% chances that a thalassaemia major baby will be born to carrier parents. To add to the disaster 5000+ infants with thalassaemia major are born annually. Experience of targeted screening has shown that around 40% of extended family members with the history of thalassaemia child may be thalassaemia carriers. The permanent cure of thalassaemia, Bone Marrow Transplantation is expensive and results not so encouraging in our set up. Therefore, the prevention is the only option to tackle this menace effectively. AIMS & OBJECTIVES: Our main objective is the screening for thalassaemia minor trait in the extended family of diagnosed thalassaemia major patients. TARGET: Ppopulation of Karachi, Hyderabad (initial stage) TASK: Prevention and Prenatal diagnosis which help us in prevention of birth of thalassaemia major patients. Premarital screening and discourage consanguineous marriages, it is simple in implementation and very effective in preventing marriage between two thalassaemia carriers. APPROACH: a. Close Relatives (Brothers + sisters, maternal + paternal relatives) b. Selection of high risk families (H/O thalassaemia major patients in family) METHOD AND DIAGNOSTIC CRITERIA: We started extended family screening of registered thalassaemia major patients to identify the carrier of the disease. Carrier is asymptomatic condition, often detected only when iron therapy for mild microcytic hypo chromic anaemia fails. FIRST STEP: Blood Complete Picture: A film showing microcytic hypo chromic picture required haemoglobin electrophoresis and hence patient is advised for it. DIAGNOSTIC CRITERIA: Haemoglobin Electrophoresis/HPLC: This is the diagnostic test which identifies the nature of haemoglobin chain deficiency and hence segregates minors (or carriers) from normal persons. PRENATAL DIAGNOSIS: In case of married individuals, if both are carriers, they are advised for prenatal diagnosis (Chorionic villus sampling). The expected mother is advised to undergo Chorionic Villus Sampling (CVS), in first triamister to detect whether fetus is major carrier or normal. RESULTS: Attached with presentation CONCLUSION: In order to achieve our goal of a thalassaemia free society, we need collaboration among NGO’s and different relevant sectors of our society in order to overcome the various hurdles in implementation of the prevention programme.

NON-INVASIVE PREDICTORS OF ESOPHAGEAL VARICES IN PATIENTS WITH HEPATITIS B AND HEPATITIS C RELATED CIRRHOSIS DR. ASMAT, DR. JAMAL ARA, DR. LIAQUAT ALI, DR. RUKHSANA, DR. SHAHNAZ, DR. TARIQ, DR. RASHEED, DR. TAHIR, DR. SHAM Department of Medicine (Ward-5) Jinnah Postgraduate Medical Centre, Karachi OBJECTIVE: To identify noninvasive predictors of esophageal varices in patients with Hepatitis B & C related cirrhosis. METHODS: All patients with Hepatitis B & C related cirrhosis who presented to the Medical Unit 1 via OPD from July 2009 to December 2009 were enrolled in the study. All patients underwent endoscopy to see the presence of varices which were graded following the standard criteria & haematological, biochemical and ultrasonographic variables. RESULTS: A total of 64 patients were enrolled in the study, mean age was 40+_ 20, male to female ratio was 2:1.Portal vein diameter, Spleen size, Platelet count & Platelet count/Splenic size ratio was strongly correlated with varices. CONCLUSION: Portal vein diameter, Platelet count, Splenic size & Platelet count/Splenic size ratio are good predictors of esophageal varices in patients with Hepatitis B & C related cirrhosis

ELECTROCARDIOGRAPHIC FINDINGS IN ACUTE STROKE
SHAFQAT HUSSAIN, JAMAL ARA, LIAQUAT ALI, RUKHSANA A. SATTAR, RASHEED DURRANI, SHAM KUMAR, TAHIR ANSARI, TARIQ AZIZ, SHAHNAZ SHAH, NARESH MODI Department of Medicine (Ward-5) Jinnah Postgraduate Medical Centre, Karachi INTRODUCTION: Stroke is defined as focal neurological deficit due to vascular lesion lasting longer than 24 hours. It is third most common cause of death in developed countries. There are different pathological processes involved in causing stroke but leading cause is vascular in origin. Hospital mortality in stroke patients is mostly of cardiac origin. Repolarization and ischemic like ECG changes observed during acute phase of stroke may cause diagnostic and management dilemmas for the clinician. Such ECG changes were present in more than 90% of unselected patients with stroke3. Patients with ECG abnormalities in acute stroke should be advised for long term follow up to predict outcome as well. OBJECTIVES: To determine frequency and significance of ECG changes in acute stroke. METHODOLOGY: Cross sectional study in Medical Unit-1 (Ward-5), Jinnah Postgraduate Medical Centre, Karachi, Pakistan from June, 2009 to November 2009. Patient with CVA within 24 hours with history of Hypertension, Diabetes Mellitus, Peripheral vascular disease were included. Other causes of stroke (cerebral tumors, tuberculosis) were excluded from the study. RESULTS: Out of 100 patients 70% were male, 30% were female, 40% has

CLINICAL CHARACTERISTICS AND LIVER BIOPSY OF CHRONIC HEPATITIS C: NONRESPONDERS AND RELAPSERS TO PREVIOUS CONVENTIONAL INTERFERON PLUS RIBAVIRIN THERAPY
1 DR.

AMANULLAH ABBASI, 2 DR. NAZISH BUTT, 3 DR. ABDUL RABB BHUTTO, 4PROF. S.M. MUNIR 1Senior Registrar, 2Postgraduate, 3Postgraduate, 4Head of Department Department of Medicine (Ward-7) Jinnah Postgraduate Medical Centre, Karachi OBJECTIVE: The aim of this study is to evaluate the clinical characteristics and liver histology of chronic hepatitis C patients, nonresponders and relapsers to previous conventional interferon plus ribavirin therapy. DESIGN: Descriptive case series PLACE AND DURATION OF STUDY: Jinnah Post Graduate Medical Centre Karachi. Hepatology section of Medical Unit-III, Ward- 7 from January 2008 to December 2008. PATIENTS AND METHODS: We recruited 109 male and female outpatients aged =17 years old with serological evidence of chronic hepatitis C by an anti HCV antibody test and quantifiable serum HCV RNA, who had previously received

ischemic stroke, 60% had haemorrhagic. It has been observed 68% had Tachycardia, 54% had T-wave inversion, 18% has LVH, 16% has Myocardial Infarction and remaining of sample size were found to be within normal limits. CONCLUSION: Most of patients with ischemic stroke had ischemic changes on ECG while the patients with haemorrhagic stroke had rhythm abnormalities. Patient with rhythm abnormalities has high mortality whereas patient with other ECG changes had a good outcome

were segregated. Special emphasis was given to the presenting signs and symptoms and those patients were followed throughout their course of treatment. Data were categorized in a statical manner starting from the time of arrival at the hospital and the treatment given, up until the final outcome of the patient. RESULTS: In the year 2009 including 41 patients admitted during the outbreak of methanol ingestion in Sept’ 2007 a total of 69 patients were hospitalised with methanol poisoning. With ages ranging from 19-60 years, 36 of them were NonMuslims and 33 Muslims majority of them belonging to low socioeconomic strata. 38/69(55%) patients after successful emergency treatment were discharged. Out of those 38 survivors 12(31%) developed CNS effects and optic neuritis as a sequel. 31/69(45%) died despite prompt and vigorous treatment within a few hours of admission almost all of them were the ones who had presented late after ingestion 30/31(97%) presented with stupor or coma at the time of admission 29/31(93%) patients had a blood PH < 7, 27/31(87%) patients had a blood Bicarbonate level < 5 all of them with a compensatory metabolic alkalosis, 25/31(80%) of them had ingested large amounts of methanol according to the attendants. CONCLUSION: Methanol intoxication is common in low socioeconomic strata due to easy availability and at lower price then ethanol containing beverages. Factors determining poor prognosis were, late presentation, stupor or coma at the time of presentation, degree of metabolic acidosis especially when there is a rising carbon dioxide (loss of compensatory respiratory alkalosis) as well as on concentration or amount of methanol ingested.

CHANGING TREND OF VIRAL HEPATITIS – “A TWENTY ONE YEAR REPORT FROM PMRC RESEARCH CENTRE, JPMC KARACHI”
WAQUARUDDIN AHMED, HUMA QURESHI,* AMBREEN ARIF, SYED EJAZ ALAM Pakistan Medical Research Council, Research Centre, Jinnah Postgraduate Medical Centre, Karachi *Pakistan Medical Research Council, Islamabad OBJECTIVE: To see the frequency and pattern of Viral Hepatitis over the past twenty one years, in a Liver Research unit of Karachi. SETTING: Out patients department of a Liver Research unit of Pakistan Medical Research Council, Jinnah Postgraduate Medical Centre, Karachi. SUBJECTS AND METHODS: Retrospective analysis of the records of PMRC, Research Centre, Jinnah Postgraduate Medical Centre, Karachi, from 1987 to 2007 were reviewed. A special flow sheet was made where information of all patients with viral liver disease was entered. Only patients having complete information of viral markers were finally included in the analysis. Cases with HBsAg and Anti HBc IgM positive and raised ALT were considered acute Hepatitis B. HBs Ag/ Anti HBc IgG positive were considered chronic Hepatitis B, Delta antibody positive with or without HBsAg were considered as Delta Hepatitis Anti HCV positive and raised ALT more than ten times for less than 6 months were considered as acute Hepatitis C, whereas Anti HCV and HCV-RNA positive with or without raised ALT for more than six months were considered as chronic Hepatitis C, Anti HEV IgM and Anti HAV IgM positive were considered as acute Hepatitis E and A respectively. RESULTS: A total of 5193 cases fulfilling all criteria of viral hepatitis were seen in the past 21 years. Of the total 3247 (62.5 %) were males and 1946 (37.5 %) females giving a male to female ratio of 1.7:1 Hepatitis C was the most common infection seen in 2896 cases (55.8 %), followed by Hepatitis B in 1691 cases (32.6 %). Hepatitis B and C both were more prevalent amongst males. Seventy five percent (75%) cases of Hepatitis B were males and 25 % females while 55% Hepatitis C cases were males and 45 % females. Hepatitis B was seen a decade earlier than hepatitis C all over . Out of a total of 5193 cases 2294 (44.1%) were chronic hepatitis, 1430 (27.5%) cirrhosis, 1083 (20.8%) carriers and 346 (6.7%) cases were having acute hepatitis(( hepatitis B 214(61.8%),hepatitis C 21(6.0%), HBV& HCV both 3 (1.3%), hepatitis E 70 (20.2%) hepatitis A 12 (3.5%)and all markers negative 26 (7.5%)cases)). Forty cases (0.7%) were of Hepatocellular carcinoma. Year wise analysis of proportion of Hepatitis B and C showed gradual decline of Hepatitis B and rise of Hepatitis C with a transition period between 1995 and 1996. CONCLUSIONS: Hepatitis C is the most common viral hepatitis, followed by hepatitis B both are more common in males. Hepatitis B is seen a decade earlier than hepatitis C. Rising trend of hepatitis C and declining evidence of hepatitis B could be due to increased awareness and detection of hepatitis C and effective vaccination for hepatitis B in the country.

CLINICAL SPECTRUM OF TETANUS AND FACTORS INFLUENCING ITS MORTALITY IN A TERTIARY CARE HOSPITAL TASNIM AHSAN, ZEENAT BANU, NIAZ AHMED, ALI SHAHEER, SUBHEEN KANWAL Department of Medicine, (Medical Unit-II) Jinnah Postgraduate Medical Centre, Karachi OBJECTIVE: To determine frequency of various clinical manifestation of tetanus and the effect of different factors on its outcome and hospital stay STUDY DESIGN: Descriptive, Case Series SETTING AND DURATION: Department of Medicine, Medical Unit II, Jinnah Postgraduate Medical Centre, Karachi, from 1st July 2009 to 31ST December 2009 PATIENTS AND METHODS: Nine patients admitted with clinical diagnosis of tetanus were included in the study. In our study we followed standard protocol of treatment. Effect of study variables like age, history of injury, type of wound, time to reach hospital, time to receive immunoglobulin after the onset of suymptoms, autonomic instability, fits, asphyxia and history of immunization, on outcome and hospital stay was assessed .The data was analyzed on SPSS version 12.Frequency and percentage was computed for study variables. Mean and standard deviation were calculated for quantitative variables. P-value of less than 0.05 was considered significant. RESULTS: Out of nine patients, eight (88.9%) were males and one (11.1%) was female; the median age was 30.4 +/-15.1 years (range: 13-60 years). Eight of them had history of injury. None had a definite history of previous vaccination with tetanus toxoid. All patients had trismus, neck stiffness, abdominal rigidity and constipation. Six (66.7%) of them had fits. The mean age of patients who expired was older with 41+/- 15.3 years as compared to that of discharged patients which was 22 +/- 8.9 years. Patients who expired were more serious with a shorter hospital stay of 21 days as compared to 6.7 days in discharged patients. Three patients had autonomic instability and all of them expired. The time taken for patients to reach the hospital and to receive immunoglobulin had no effect on outcome. The overall case-fatality rate was found to be 44.4 %. CONCLUSION: Tetanus remains a major health problem world wide. Increasing age and autonomic instability predicts poor outcome. Early diagnosis is necessary to institute appropriate management and was found to be associated with good prognosis and functional recovery. KEY WORDS: TIG=tetanus immunoglobulin.

PREVALENCE AND FATALITY RELATED TO METHANOL POISONING A STUDY CONDUCTED IN NATIONAL POISON CONTROL CENTRE JPMC KARACHI.
PROF. JAMAL ARA, *DR. AYESHA WAGGAN, DR. LIAQUAT ALI, DR. RUKHSANA SATTAR, DR. ABDUL RASHEED DURRANI, DR. TAHIR ANSARI, DR. TARIQ, DR. SHAAM, DR. SHEHNAZ SHAH *Resident Medical Ward-5 Jinnah Postgraduate Medical Centre, KARACHI BACKGROUND: Methanol poisoning is rare but undeniably the most life threatening. Studies have been done and Data has been published on the treatment options but we felt a need for the study emphasising on the prevalence and major causes predisposing to and associated with fatality even after efficient hospital management. Therefore we conducted a survey in the National Poison Control Centre JPMC Karachi focusing on mortalities due to methanol poisoning during the year 2009 including the methanol poisoning outbreak in Sept’ 2007. OBJECTIVE: To ascertain the causes of high prevalence and determining the factors related to mortality following methanol intoxication by observing the condition of patients at the time of admission and following their step by step management. METHOD: Patients admitted in Poison control centre after alcohol ingestion were traced out through hospital records, out of those the cases of methanol intoxication

DENGUE FEVER RELATED ACALCULOUS CHOLECYSTITIS
TASNIM AHSAN, ZEENAT. BANU, UMAR FAROOQ, TARIQ MEHMOOD Department of Medicine, (Medical Unit-II) Jinnah Postgraduate Medical Centre, Karachi OBJECTIVE: To determine the frequency of various symptoms, in particular serositis and acalculous cholecystitis in patients with a diagnosis of dengue fever (DF) and requirement of platelet transfusion in these patients. STUDY DESIGN: Descriptive, Case Series.

SETTING AND DURATION: Department of Medicine, Medical Unit II, Jinnah Postgraduate Medical Centre, Karachi, from October 2009 to December 2009. PATIENTS AND METHODS: 18 patients admitted with diagnosis of DF according to clinical manifestations and confirmed by a positive IgM antibody test, were included in the study. Frequency of study variables like fever, rash, myalgia, arthralgia, headache, abdominal pain, vomiting, chills, and diarrhea, were recorded. Ultrasonography was performed to look for ascites, acalculous cholecystitis, hepatosplenomegaly and pleural effusion. . Ultrasonographic criteria for diagnosis of acalculous cholecystitisis include gallbladder wall thickening (over 3mm), distention of gallbladder, pericholecystic fluid and sludge. The data was analyzed on SPSS version 12.Frequency and percentage was computed for study variables. Mean and standard deviation were calculated for quantitative variables. P-value of less than 0.05 was considered significant. RESULTS: Out of 18 patients, 10 (55.6%) were males and 8 (44.4%) were females; the median age was 26.7±13.9 years (range: 14-57years). Seven (38.9%) of them were found to have acalculous cholecystitis. Common features were hepatomegaly in nine (50%) splenomegaly in eight (44.4%), bleeding in eleven (61.1%) from either single (38.9%) or multiple (22.2%) sites, ascites in three (16.7%) and pleural effusion in two (11.1%).Although these were seriously ill patients, only eight (44.4%) of total patients required platelet transfusion. CONCLUSION: Acalculous cholecystitis can occur in dengue fever and dengue hemorrhagic fever but reports are rare. In our study, approximately 44.4% of the DF patients had acalculous cholecystitis. Treatment is conservative unless there is no resolution. Dengue fever and Dengue Hemorrhagic fever being highly endemic, there is a need to be familiar with the atypical presentation of this increasingly prevalent disease. Platelet transfusion is not required in all patients. KEY WORDS: DF dengue fever, Acalculous cholecystitis.

health issue which has been recognized as an important co-morbid condition for diabetes with relative risk of 1.3-3.0 times as seen in some studies. OBJECTIVES: To determine the prevalence of depression and its association with diabetes in a high risk population of Pakistan. METHODS: A joint collaborative primary prevention study was initiated in 2007 between university of Oslo, Diabetes Association of Pakistan and Baqai Institute of Diabetology & Endocrinology for a period of three years. Total 1,822 high risk subjects aged > 30 yrs were screened by OGTT, out of which 1,246 were agreed for the assessment of depressive symptoms according to Montgomery Asberg depression rating scale. Demographic and socioeconomic information was collected through a structured questionnaire. Subjects identified as having IGT were invited to participate in the intervention program for a period of 18 months. Depressive symptoms were assessed again at 18 months while OGTT, fasting lipid profile, fasting insulin and HbA1c were done at 0, 9 and 18 months. RESULTS: Out of 1,246 subjects (68.4%) were males and (31.5%)) were females. Subjects with diabetes had high prevalence of depression (13% n=16/123) as compare to non-diabetics (6.77%). Mean age of the cohort was 42 yrs (±9.37) while mean BMI was 26.31 ±5 13 kg/m².One hundred and twenty three (9.9%) were found to be diabetic and 92 (7.4%) had depression. Only 16(1.28%) had depression with diabetes. In females depression rate was high (15.52%) as compared to males (3.63%). Diabetes, female gender, non earners and obesity were significantly associated with depression. (P value = 0.03) CONCLUSION: Low prevalence of depression was seen in this population. Significantly high percentage of depression was found in newly diagnosed diabetics compared to non diabetics. It is suggested that along with lifestyle modification, psychiatric intervention and counseling of high risk individuals is needed for primary prevention of diabetes.

RELATION OF BRAIN NATRIURETIC PEPTIDE, MEAN ARTERIAL AND PULSE PRESSURES AMONG NORMOTENSIVE, PREHYPERTENSIVE AND HYPERTENSIVE MALE COHORT
*MEH JABEEN; MUHAMMAD FURQAN; MRS.NUDRAT ANWAR ZUBERI *Assistant Professor, Department of Physiology Hamdard College of Medicine and Dentistry, Hamdard University, Karachi BACKGROUND: Hypertension is an increasingly important medical and public health issue. Individuals prone to the development of hypertension often have a hyperdynamic circulation antedating the onset of hypertension by several years. Brain Natriuretic Peptide is a new promising cardiovascular risk marker due to its association with high blood pressure via its mechanisms of secretion and actions. Both pulse and mean arterial pressures are independent markers of cardiovascular diseases. This study was designed to find out any relation between the rising values of pulse and mean arterial pressures among normotensives, pre-hypertensives and newly diagnosed hypertensives with the changes in plasma brain natriuretic peptide levels. METHODS: This was an observational, analytical cross-sectional study conducted in department of physiology at Basic Medical Sciences Institute, Jinnah Post Graduate Medical Center, Karachi. Study included 85 adult males, aged between 20-60 years, non- smokers, non- diabetic and having no other chronic illness. Pulse and mean arterial pressure values were found.Study participants were divided into three groups on the basis of normotensive to hypertensive as stated by Joint National Committee -7. Brain Natriuretic Peptide was assayed by AxSym technology. RESULTS: Brain Natriuretic Peptide developed a positive correlation with both pulse and mean arterial blood pressures and was also found out to be significantly raised in pre-hypertensive group. CONCLUSION: This study concluded that Brain Natriuretic Peptide is positively related with increasing values of both variables i.e. pulse as well as mean arterial blood pressures. It also concluded Brain Natriuretic Peptide to be significantly elevated in pre-hypertensive stage and not very different from the levels of sustained hypertension. KEY WORDS: Brain Natriuretic Peptide, Pre-hypertensive, Pulse pressure, Mean arterial blood pressure.

HYPERGLYCEMIC EMERGENCIES & ITS PRECIPITATING FACTORS
MUHAMMAD RIZWAN, TAHIR ANSARI, JAMAL ARA, LIAQAT ALI, RUKHSANA A.SATTAR, TARIQ AZIZ Department of Medicine (Ward-5) Jinnah Postgraduate Medical Centre, Karachi INTRODUCTION: Hyperglycemic emergency is a state of uncontrolled diabetes in which the degree of metabolic derangement is such that immediate administration of insulin and fluids is required to save the patient’s life. Diabetic ketoacidosis DKA and hyperglycemic non-ketotic diabetic coma HONK are the main types of hyperglycemic emergencies, these complications are life-threatening and therefore require early recognition and immediate management. OBJECTIVE: To determine the precipitating factors, clinical features & outcome of hyperglycemic emergencies. METHOD: Cross sectional study conducted at medical unit -1, JPMC, Karachi from December 2008 to November 2009. All patients with symptoms of acute metabolic decompensation & plasma glucose level > 250 mg/dl in previously known to have diabetes or diagnosed with diabetes on admission were included. All the relevant information i.e demographic & socioeconomic was collected through a questionnaire. RESULT: A total no. of 42 patients were enrolled, there were 24 males (57%) & 18 females (43%). Age ranges from 14-72 years with mean age of 43±. Among 42 patients 38(90.4%) were diagnosed as DKA & 4 (9.6%) as HONK. On admission majority (46%) of patients were irritable/restless, 28% comatose, 17% with abdominal pain & vomiting & 9% with neurological deficit. Precipitating factors noted in these patients were infections; 40%, poor compliance; 32%, CVA;12%, trauma;8%, Unknown;8%. Total 7 (16.5%) patients died out of which 6(14.2%) due to DKA & 1(2.3%) due to HONK. CONCLUSION: Hyperglycemic emergencies are largely precipitated by infections & poor compliance and are associated with considerable mortality. SIGNIFICANCE OF LUNG FUNCTION TEST [SPIROMETRY] IN DIABETIS PATIENTS

DEPRESSION AND DIABETES IN HIGH-RISK URBAN POPULATION OF PAKISTAN
*FAREEHA SHAIKH, SHAHEEN ASGHAR, M. ZAFAR IQBAL HYDRIE, ASHER FAWWAD, ABDUL BASIT, A SAMAD SHERA, AKHTAR HUSSAIN *Research Officer, BIDE-DAP-UIO Project Baqai Institute of Diabetology and Endocrinology Baqai Medical University, Karachi INTRODUCTION: Diabetes prevalence is increasing worldwide with the major burden occurring in the developing countries. Depression is a common public

SULTAN AYOUB MEO Professor and Consultant Department of Physiology, College of Medicine King Khalid University Hospital, King Saud University, Saudi Arabia & Associate Editor International Journal of Diabetes Mellitus [Elsevier / Science Direct] {E-mail: sultanmeo@hotmail.com} Spirometry is a widely used pulmonary function test (PFT), ideally suited to describing the effects of obstruction or restriction on lung function. It is a powerful diagnostic tool that plays a significant role in the early diagnosis of lung damage and its associated structures. The Spirometric parameters have gained more popularity when it has been reported that impaired Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 s (FEV1) are emerging novel risk factors for type 2 diabetes mellitus. These Spirometric parameter derangements have been evident on spirometry long before the clinical diagnosis of diabetes mellitus or insulin resistance. Therefore, the aim is to highlight the evidence based significance of spirometry in this scientific symposium. It may serve as a brief reference for diabetes management teams to enable spirometry to be included in the algorithm of the routine assessment of diabetic patients.

(.6%) and thyrotoxicosis without goiter in 26(8..4%). Out of 201 patients who came for follow-up after 6 weeks, irrespective of treatment received, 91 (45.27%) patients became euthyroid, 39 (19.40%) were still toxic but there hormonal profile was better than before, 32 (15.9%) had no change in their status and 39 (19.40%) became hypothyroid. CONCLUSION: Thyrotoxicosis is more common in female patients. Diffuse Toxic Goiter is the most common form of Thyrotoxicosis. A substantial proportion of patients with Thyrotoxicosis had no goiter which may cause delay in their diagnosis. Most of the patients were rendered euthyroid on their first follow-up, but a small number of patients were also rendered hypothyroid.

CONFUSING PHENOTYPES OF POLYCYSTIC OVARIES IN ENDOCRINE CLINIC
TASNIM AHSAN, ZEENAT BANU, SAIMA GHAUS, RUKHSANDA JABEEN, UMAR FAROOQ Department of Medicine, (Medical Unit-II) Jinnah Postgraduate Medical Centre, Karachi OBJECTIVE: To study the various phenotypes of polycystic ovarian syndrome in our population. METHODOLOGY: This is a descriptive study conducted in Medical Unit II of Jinnah Postgraduate Medical Centre (JPMC), Karachi from February 2007 to July 2009. All patients with clinical diagnosis of PCOS, visiting Endocrine Clinic, JPMC, were enrolled in the study. Detailed history and clinical examination was done and proforma was filled accordingly. They were assigned five different phenotypes: Phenotype A with ovulatory dysfunction, hirsutism and polycystic ovaries; Phenotype B with ovulatory dysfunction and hirsutism; Phenotype C with ovulatory dysfunction and polycystic ovaries; Phenotype D with hirsutism and polycystic ovaries; Phenotype E with solitary ovulatory dysfunction. Patients with Congenital adrenal hyperplasia, Thyroid disorders, Cushing’s and Turner’s syndrome were excluded from this study. The data was analyzed on SPSS version 12.Frequency and percentage was computed for study variables. Mean and standard deviation were calculated for quantitative variables. P-value of less than 0.05 was considered significant. RESULTS: Out of 77 patients, 40 (54.8%) were single and 30 (41.1%) were married; the median age was 25.2 +/_ 6.0 years (range: 12-38 years). The most common clinical presentation was menstrual irregularity 68 (88.3%), obesity 50 (63.3%) followed by hirsutism 41 (51.9%), infertility 25 (34.7%) and acne 24 (30.4%). The most commonly occurring phenotype was E, that was in 26 (33.8%) patients, followed by phenotype B, that was in 22 (28.6%) patients. CONCLUSION: PCOS has a variable clinical presentation in our population ranging from features of irregular menstruation to features of insulin resistance and infertility. The most common phenotype was E. KEYWORDS: Polycystic Ovarian Syndrome, Hyperandrogenism, Oligomenorrhea, Amenorrhea.

HYPERGLYCEMIC EMERGENCIES & ITS PRECIPITATING FACTORS
MUHAMMAD RIZWAN, TAHIR ANSARI, JAMAL ARA, LIAQAT ALI, RUKHSANA A.SATTAR, TARIQ AZIZ Department of Medicine (Ward-5) Jinnah Postgraduate Medical Centre, Karachi INTRODUCTION: Hyperglycemic emergency is a state of uncontrolled diabetes in which the degree of metabolic derangement is such that immediate administration of insulin and fluids is required to save the patient’s life. Diabetic ketoacidosis DKA and hyperglycemic non-ketotic diabetic coma HONK are the main types of hyperglycemic emergencies, these complications are life-threatening and therefore require early recognition and immediate management. OBJECTIVE: To determine the precipitating factors, clinical features & outcome of hyperglycemic emergencies. METHOD: Cross sectional study conducted at medical unit -1, JPMC, Karachi from December 2008 to November 2009. All patients with symptoms of acute metabolic decompensation & plasma glucose level > 250 mg/dl in previously known to have diabetes or diagnosed with diabetes on admission were included. All the relevant information i.e demographic & socioeconomic was collected through a questionnaire. RESULT: A total no. of 42 patients were enrolled, there were 24 males (57%) & 18 females (43%). Age ranges from 14-72 years with mean age of 43±. Among 42 patients 38(90.4%) were diagnosed as DKA & 4 (9.6%) as HONK. On admission majority (46%) of patients were irritable/restless, 28% comatose, 17% with abdominal pain & vomiting & 9% with neurological deficit. Precipitating factors noted in these patients were infections; 40%, poor compliance; 32%, CVA;12%, trauma;8%, Unknown;8%. Total 7 (16.5%) patients died out of which 6(14.2%) due to DKA & 1(2.3%) due to HONK. CONCLUSION: Hyperglycemic emergencies are largely precipitated by infections & poor compliance and are associated with considerable mortality.

C L I N I C A L S P E C T R U M A N D VA R I O U S THYROTOXICOSIS IN ENDOCRINE CLINIC

FORMS

OF AN AUDIT OF PITUITARY TUMORS IN PATIENTS PRESENTING TO THE ENDOCRINE CLINIC OVER A PERIOD OF 3 ½ YEARS
TASNIM AHSAN, I. H. BHATTI, TAMSEELA AHMED Department of Medicine, (Medical Unit-II) Jinnah Postgraduate Medical Centre, Karachi This is a descriptive study about pituitary tumors with reference to age of presentation, sex distribution, clinical presentation, type of pituitary tumor classified as macroadenoma, microadenoma and craniopharyngioma and by laboratory investigations whether hormonal excess and/or failure, their management and outcome of patients.

TASNIM AHSAN, RUKHSHANDA JABEEN, ZEENAT BANO, M. UMAR FAROOQ, MAHESH BATRA Department of Medicine, (Medical Unit-II) Jinnah Postgraduate Medical Centre, Karachi OBJECTIVE: To study the frequency of various symptoms, signs and forms of Thyrotoxicosis. METHODOLOGY: This is retrospective study conducted in Endocrine Clinic, Medical Unit-II, JPMC, Karachi. All patients with diagnosis of Thyrotoxicosis, registered in Endocrine Clinic from April, 2007 to June 2009 were analyzed. Detailed history and clinical examination were done and were recorded on a predesigned structured questionnaire. RESULTS: Out of 310 patients, 258(83.2%) were female. Common presenting symptoms were palpitation in 260(83.9%), heat intolerance in 213 (68.7%) weight loss in 200 (64.5%) and tremors in 187 (60.3%). Common clinical features include goiter in 257 (82.9%), tachycardia in 83 (25.77%), eye signs were present in 79 ( 25.48%) patients. Exophthalmos was present in 64 (20.6%), lid lag in 12 (3.9%) and lid retraction in 3 (1%) patients. Most common form of thyrotoxicosis was diffuse toxic goiter in 159 (51.3%) patients followed by toxic multinodular goiter in 62 (20%), solitary toxic nodule in 39 (12.6%), subclinical hyperthyroidism in 14 (4.5%), thyroiditis in 8 (2.6%), thyrotoxicosis with solitary cold nodule in 2

ASSESSMENT OF INSULIN RESISTANCE IN SOUTH EAST ASIAN WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS)
MUSARRAT RIAZ, ABDUL BASIT, ASHER FAWWAD, MUHAMMAD YAKOOB AHMEDANI, ASIM BIN ZAFAR, ZAHID MIYAN, AHMED SALMAN Consultant Physician, Department of Medicine Baqai Institute of Diabetology and Endocrinology Baqai Medical University, Karachi {Email: } OBJECTIVE: To assess insulin resistance (IR) in South East Asian women with PCOS. METHODS: This cross sectional study was carried out at Baqai Institute of Diabetology and Endocrinology (BIDE) from January 2006 to December 2008. Patients fulfilling the revised 2003 Rotterdan diagnostic criteria for PCOS were included. Data of 91 patients was available for statistical analysis. Descriptive statistics were calculated using frequency and mean with standard deviation IR was calculated using fasting blood sugar (FBS) and fasting insulin levels. Different surrogate marker of IR like Homeostatic model assessment of IR (HOMA-IR) and quantitative sensitivity check index (QUICKI) were calculated. RESULTS: The mean BMI of patients with PCOS was 31.85 ± 7.93. 37% of patients were infertile. Co-morbid like type 2 diabetes was seen in 12.7% patients while 15.11% patients were hypertensive. Using HOMA-IR (=2.6) 70% patients were insulin resistant while with QUICKI (=0.35) IR was seen in 88% patients. Only 43.9% of patients were having typical cystic appearance of ovaries on ultrasound. CONCLUSION: Frequency of insulin resistance in patients with PCOS is quite high in South East Asian women. Further large scale studies are needed to validate the findings of this study, so that the long term sequel of IR can be prevented.

RESEARCH DESIGN AND METHODS: This study was done at the Aga Khan University Hospital Karachi. Data was collected prospectively by using a questionnaire which included demographic characteristics and individual components of metabolic syndrome i.e. waist circumference, serum triglyceride, HDL etc. This data was analyzed separately according to NCEP ATP III, IDF and WHO definitions and the results were then compared. The data were presented as the mean +/- SD or percentage; continuous variables were compared using the chi-square test. All analyses were conducted by using the statistical package for social sciences SPSS 14. All p values were two sided and considered as statistically significant ifÊÊ 0.05. RESULTS: Two hundred and ten Type 2 diabetic patients were enrolled in the study among which 112 were males and 98 females. The frequency of Central Obesity by WHO were 96%, by NCEP ATP III (europoid) 61.4%, by NCEP ATP III (southasian) and IDF definitions was 90.5%. Hypertension by WHO criteria was present in 55.2% in comparison to prevalence of around 70% by both ATP III and IDF definitions. Hypertriglyceridaemia was present in 41.4% by all definitions. However prevalence of low HDL differed being 36.7% for WHO and 67.6% for ATP III and IDF definitions. The prevalence of Metabolic Syndrome was 81.4% by WHO definitions, 75.7 and 91.9% by NCEP ATP III (europoid) and NCEP ATP III (southasian) and 86.7% by IDF criteria. The degree of agreement (kappa statistic) between WHO definition and NCEP ATP III (europid), NCEP ATP III (southasian), IDF definitions were 0.465, 0.436 and 0.417 respectively. The degree of agreement between IDF and NCEP ATP III (europid), (southasian) definitions was found to be 0.373 and 0.728 respectively. CONCLUSION: Prevalence of Metabolic Syndrome in Type 2 Diabetics was highest according to NCEP ATP III southasian criteria followed by IDF and WHO definitions. NCEP ATP III europoid had the lowest prevalence. Maximum degree of agreement was seen between IDF and NCEP ATP III southasian definitions of metabolic syndrome.

DIABETES RELATED KNOWLEDGE AMONG RESIDENTS AND NURSES: A MULTICENTER STUDY IN KARACHI, PAKISTAN
ASMA AHMED, LUBNA ZUBAIRI, MUHAMMAD ISLAM, KHUSRO SHAMIM, ABDUL JABBAR Endocrine Section/ Department of Medicine The Aga Khan University Hospital OBJECTIVE: To evaluate and compare the knowledge related to the management of diabetes among nurses and trainee residents of internal medicine, family medicine and surgery at tertiary care hospitals of Karachi, Pakistan. METHODS: A validated questionnaire consisting of 20 questions related to diabetes awareness was acquired through a study done at Thomas Jefferson University Hospital, Philadelphia with the consent of primary author. The survey was performed at five tertiary care academic hospitals i among residents and nurses. RESULTS: 169 internal medicine residents (IMR), 27 family medicine residents (FMR), 86 surgery residents (SR) and 99 nurses (RN) participated. The overall mean correct percentage was 50%. ÊThere was no difference in total mean scores of IMR & FMR (64% versus 60%, p= 0.47), although the total scores of SR and RN were quite low (39% & 31% respectively). R.N didn’t answer correctly on most of the items regarding in patient management of diabetes (Mean correct score 40%). CONCLUSION: As there are no prior studies in our setting evaluating knowledge related to diabetes management among trainee residents and nurses, this study is quite significant. Based on these results, there are significant gaps in diabetes knowledge among residents and nurses. Most current curricula in medical and nursing schools do not include practical diabetes management.Ê Due to high burden of disease and considering the fact that our residents and nurses are actively involved in diabetes management this raises important concerns and needs to be addressed.

IS SERUM ADIPONECTIN A PRECURSOR OF T2DM?
AHSAN S, KARIRA KA, HAQUE MS, ZUBARI NA, HYDRIE MZI, KHANAM R. Baqai Institute of Diabetology and Endocrinology Baqai Medical University, Karachi BACKGROUND: Diabetes is the result of glucose dysregulation and it passes from normal glucose tolerant (NGT) to prediabetes and then to diabetes. The first phase of this spectrum from NGT to pre-diabetes is reversible and also preventable. Therefore, it is imperative to understand the pathophysiology of prediabetes. Adiponectin is a peptide hormones synthesize exclusively from adipose tissues. Studies revealed that adiponectin has insulin sensitizing property. Adiponectin knock out mice were found to be insulin resistant and on administration of adiponectin insulin sensitivity was restored. Studies found decreased adiponectin in diabetic and insulin resistant subjects. AIM: We attempted to find the status of serum adiponectin in individuals progressing towards T2DM and compare it with NGT subjects, to determine the stage where alteration of adiponectin occurred. METHODS: This study was carried out in the Department of Biochemistry, BMSI, JPMC, Karachi during Jan to Aug 2008. Subjects were invited through various diabetes screening camps. A total of 608 subjects = 30 years of age with out prior history of diabetes were screened through FPG and 2 hour OGTT. Individuals with diabetes were excluded from the study. Forty prediabetic subjects and forty age and sex matched NGT subjects were included in the study. Anthropometric measurements were done. Serum insulin and adiponectin were estimated by ELISA while HOMA-IR was calculated mathematically. RESULT: Mean BMI, waist, hip circumference and B.P were significantly raised in prediabetics compared to NGT. Adiponectin was significantly decreased while insulin and HOMA-IR were raised in prediabetics. Adiponectin showed significant negative correlation with insulin (r= -0.73) and HOMA-IR (r= -0.71). CONCLUSION: We found low adiponectin in prediabetic subjects and its estimation may help in earlier identification of impending diabetes. However, casual link between adiponectin and prediabetes remained unexplored due to small sample size, which warrants longitudinal large scale studies.

COMPARISON OF METABOLIC SYNDROME PREVALENCE IN TYPE 2 DIABETICS USING NCEP ATP III, IDF AND WHO CRITERIA’S
AHMED A, N ISLAM, T YASMEEN AND T E KHAN Endocrine Section, Department of Medicine Aga Khan University Hospital, Karachi OBJECTIVE: Metabolic Syndrome has emerged as a significant burden on health all over the world. Many Definitions have been put forward since the inception of this Syndrome. Studies have looked into these differences in definitions of metabolic syndrome generally, but only few studies have compared these definitions in the diabetic population. We decided to determine the prevalence of metabolic syndrome in Type 2 diabetics according to NCEP ATPIII, IDF and WHO definitions and then to compare and contrast these traits within Pakistani population.

ASSOCIATION OF FTO AND MC4R GENES WITH OBESITYRELATED TRAITS AND TYPE 2 DIABETES IN PAKISTANI POPULATION
DR. SHAZIA KIRAN Research Department Baqai Institute of Diabetology and Endocrinology Baqai Medical University, Karachi OBJECTIVE: A number of studies have shown that common variants within the FTO and MC4R genes are associated with obesity-related traits such as BMI, weight and waist circumference. Recent studies of Indian population have also revealed that variants within FTO appear to be associated with type 2 diabetes. A joint collaborative study was conducted between Baqai Institute of Diabetology and Endocrinology (BIDE),University of Birmingham and Diabetes Association of Pakistan(DAP).Our aim was to observe the association of the above mentioned SNPs with T2DM and obesity. RESEARCH DESIGN & METHODS: Subjects with type 2 diabetes (N = 717) were recruited from hospitals within Mirpur District or from specifically organized Diabetes Awareness camps. Control subjects (N = 912) were recruited from community screening camps set up through our team stationed in Mirpur. All samples (N=1629), were genotyped for the FTO rs9939609 and MC4R rs12970134 single nucleotide polymorphisms (SNPs). Genomic DNA was extracted from saliva using the Oragene® DNA sample collection kit and extraction protocol (DNAGenotek Inc., Ontario, Canada). These kits greatly simplify the collection and transportation of samples, as well as immediately stabilizing DNA, and so were chosen instead of venous blood samples. Informed consent was obtained from all study participants and the study was approved by the BIDE ethical review board. RESULTS: Both SNPs (FTO and MC4R) displayed an association with obesityrelated traits, but only within the normoglycaemic group, p values were significant for BMI (0.008),waist (0.052) and weight(0.008) in FTO and in MC4R p values for BMI (0.021),waist (0.011) and weight(0.013).No associations were found within the type 2 diabetes group for BMI, waist and weight in both FTO and MC4R. CONCLUSIONS: In this study we observed that FTO and MC4R SNPs were associated with obesity-related traits in Pakistani population, both individually and multiplicatively. These associations appear to be masked in the type 2 diabetes group.

F R E Q U E N C Y O F D I F F E R E N T PAT T E R N O F R E N A L OSTEODYSTROPHY IN END STAGE RENAL FAILURE PATIENTS ON MAINTENANCE HEMODIALYSIS
S. NOUSHEENA IQBAL, A MANAN JUNEJO, MANOHAR LAL DAWANI Department of Nephrology Jinnah Postgraduate Medical Centre, Karachi INTRODUCTION: In chronic kidney disease renal osteodystrophy (ROD) is highly prevalent. It is an important cause of morbidity, decreased quality of life, and extra skeletal calcification that have been associated with increased cardiovascular mortality. The disease is classified into following categories: 1) high turnover bone disease (osteitis Fibrosa Cystica) (2) low turnover bone disease (adynamic bone disease and Osteomalacia) (3) mixed uremic osteodystrophy (combination of osteitis Fibrosa cystica and Osteomalacia). OBJECTIVE: To determine the frequency of different patterns of renal osteodystrophy in patients of maintenance haemodialysis. MATERIAL AND METHODS: It was a prospective, cross-sectional study of renal bone disease in patients receiving hemodialysis at JPMC. A variety of noninvasive data (like parathyroid hormone, serum calcium, phosphate & alkaline phosphatase) was obtained. RESULTS: The study was carried out in 56 patients. Their average age was 45.85 ± 13.5 years. Out of 56 patients, 34 (61%) were male and 22 (39%) were female. Male to female ratio was 1:1.5. 37 (66%) patients were on twice weekly and 19 (34%) patients were on thrice weekly HD. Their mean duration of HD was 20.2±13.6 months. Higher prevalence of ROD in 89.28% (50 patients) was noted. The most common type was secondary hyperparathyroidism (osteitis Fibrosa Cystica), observed in 32% of patients. Only 15 patients (27%) had iPTH level within the target range. Hyperphosphatemia was observed in 35 patients (62%) while hypercalcaemia in only 4 patients (7%). Osteomalacia was common in adolescent age group (66%), osteitis Fibrosa cystica (OFC) in adult group (36%) while mixed variety in elder group (50%). Similarly OFC was the most common pattern in both genders.

FREQUENCY OF HEPATORENAL SYNDROME IN PATIENTS WITH LIVER CIRRHOSIS ASSOCIATED WITH HEPATITIS C VIRUS AT JINNAH POSTGRADUATE MEDICAL CENTER, KARACHI.
DR. POORAN MAL, DR.MANOHAR LAL DAWANI, DR. ABDUL MANAN JUNEJO Department of Nephrology Jinnah Postgraduate Medical Centre, Karachi OBJECTIVES: To determine the frequency of Hepatorenal Syndrome in patients with cirrhosis associated with Hepatitis C virus. STUDY DESIGN: Cross sectional PLACE AND DURATION OF STUDY: Departments of Medicine and Nephrology JPMC, Karachi, from1st December 2007 to 30th May 2008. PATIENTS AND METHODS: Data was collected from patients admitted in the medical and nephrology wards, through a pre-designed proforma. After meeting the inclusion criteria. history and systemic examination was done and investigations like blood urea nitrogen, serum creatinine, serum electrolytes, urine analysis, Anti HCV antibodies done in all these patients. RESULTS: A total of 100 patients with liver cirrhosis were included in this study. Out of 100 patients, 32 patients (32%) had renal dysfunction manifested by raised serum creatinine. Five patients (16.6%) out of 32 were diagnosed as renal dysfunction due to hypovolumia. Five (16.6%) patients with renal dysfunction were due to sepsis. Three (9.4%) patients with renal dysfunction also have the history of nephrotoxic drugs. Similarly renal dysfunction were diagnosed as cases of UTI in 2(6.3%), obstructive uropathy 1(3.13%) and shock with history of fluid loss 1(3.13%). Hepatorenal syndrome (HRS) was diagnosed in 12 patients, which is 37.5% (12/32) and overall frequency of hepatorenal syndrome (HRS) was 12(12%) of all 100 patients. CONCLUSION: Hepatorenal syndrome is a dreaded complication in patients liver cirrhosis and HCV is the major cause of end stage liver disease. There is need to educate general population about the risk factors associated with spread with hepatitis C virus. KEY WORDS: Hepatorenal Syndrome, HCV, Cirrhosis

LEFT VENTRICULAR HYPERTROPHY IN END- STAGE RENAL DISEASE PATIENTS ON MAINTENANCE HEMODIALYSIS
BHAGWAN DAS, MANOHAR LAL, ABDUL MANAN JUNEJO Department of Nephrology Jinnah Postgraduate Medical Centre, Karachi BACKGROUND: Cardiovascular disease is the principal cause of morbidity and mortality in dialysis patients. Left ventricular hypertrophy is one of the commonest structural abnormalities in patients on regular dialysis. METHODS: STUDY DESIGN: Single Center Case-Series Study. PLACE AND DURATION OF STUDY: this study was carried out at hemodialysis unit of Jinnah Post-graduate Medical Center Karachi. From May, 2009 to November, 2009 Seventy three patients on regular hemodialysis were included in the study. ECG, CXR, and two dimensional and M-Mode echocardiography was performed in all patients irrespective of the cause of renal failure. RESULTS: Total number of patients was seventy three. 33 patients were male and 40 were female. Mean age of the patients was 44.19 years. Essential hypertension was the commonest cause of renal failure that is observed in 29(39.7%) cases followed by Diabetes Mellitus and Chronic Glomerulonephritis in 20(27.4%) in each. Renal stone 4(5.5%), unresolved acute renal failure 4(5.5%) and Chronic Tubulointerstitial nephritis in 2(2.7%). Left ventricular hypertrophy was observed in 19(26%) patients. CONCLUSION: since left ventricular hypertrophy is a powerful cardiovascular risk factor for increased morbidity and mortality in hemodialysis patients, its early detection and regression of left ventricular hypertrophy will contribute to reduction in cardiovascular mortality in uremic population. KEYWORDS: Left ventricular hypertrophy, Hemodialysis, Echocardiography, End-stage renal disease

2 YEARS EXPERIENCE OF RENAL AMYLOIDOSIS
KUMAR DILEEP, A MANAN JUNEJO, MANOHAR LAL DAWANI Department of Nephrology Jinnah Postgraduate Medical Centre, Karachi INTRODUCTION: Amyloidosis is a systemic disease characterized by deposition of abnormal fibrillay proteins in the extracellular spaces of multiple organs. Renal amyloidosis is not infrequently encountered in the practice of nephrology. The kidneys are involved in almost cases of secondary amyloidosis. Its incidence has varied from 3 – 12% in different biopsy series. The renal manifestation vary with site of involvement. Most patients have predominant glomerular deposition and present proteinuria. OBJECTIVE: To detect the frequency and clinicopathologic presentation of renal amyloidsis MATERIALS AND METHODS: study was conducted at the department of Nephrology. Renal biopsies were scrutinized over period of 2 years to detect the frequency of secondary amyloidosis and pattern of the disease. Baseline labs including CBC, UCE, Total protein & albumin , urine D/R , 24 hours urinary proteins and renal biopsy were done. RESULTS: On the basis of renal biopsy total 10 patients were found to have secondary amyloidosis. Out of which 7 were male and 3 females. The age ranges 24 yrs to 55 years. 5 presented with heavy proteinuria with normal renal functions while rest of the 5 had deranged renal functions wth significant proteinuria. Tuberculosis was the most common cause of secondary amylodosis.

FREQUENCY OF CORONARY ARTERY STENOSIS AMONG PATIENTS OF STABLE ANGINA HAVING LEFT BUNDLE BRANCH BLOCK: EFFECTS OF GENDER AND AGE
AHMED S, ULLAH E, AHSAN MB, ABBAS R. {Dr Raees Abbas, 42-Doctor’s Hostel, BVH, Bahawalpur, Cell: 0321-6903704} INTRODUCTION: The purpose of the study was too see the frequency of coronary artery stenosis in the patients of stable angina having left bundle branch block, and to see the effects of gender and age on this correlation. MATERIALS & METHODS: The study design was Experimental case series at Bahawal Victoria Hospital, Bahawalpur carried out from June 2006 to May 2008. One hundred and forty one (141) patients of Stable Angina presenting with atypical chest pain, both male and female of 30—70 years age, positive for LBBB and with normal Cardio-Thoracic Ratio, normal echocardiography and negative for conventional risk factors and family history of Coronary Artery Disease were taken. All patients were angiographied. RESULTS: A total of 141 patients were investigated through coronary angiogram to see the frequency of coronary artery stenosis in these patients. Ninety five (67.4%) patients proved to have coronary artery stenosis. The male patients showed higher frequency (87.4%) of harboring coronary vessel blockade as compared to that (35.2%) in females (P value <0.0005). There was no relation between age and the frequency of coronary stenosis (P value >0.05). CONCLUSION: There is significant difference (P value <0.0005) in coronary artery stenosis among men and women having LBBB.

QUALITATIVE AND QUANTITATIVE ASSESSMENT OF CORONARY ARTERIES IN PAKISTANI POPULATION ON ANGIOGRAPHIC STUDY
DR. A RASHEED KHAN A Professor & Head of Cardiology Abbasi Shaheed Hospital, Karachi Medical & Dental College, Karachi This is an observational type of study in which we have observe the origin of Anomalous Coronary Artery and the diameter, type, severity and the site of lesion involving them. We have studied 500 patient and the incidence of Anomalous Coronary Artery was 04%, which is comparable to available International literature. It was also found out that in Pakistani Population the diameter is of smaller size, the lesion are of severe type as compare to European Countries Anomalous coronary artery is found in 04% of all patients coming for coronary angiography. The anomalous coronary artery may arise from contra-lateral coronary sinus, separately, combined from one or same sinus, above or below its normal sinus sites etc. The right coronary artery may arise from the proximal left circumflex artery sinus or Circumflex artery originating from right Coronary sinus and Left anterior descending artery from the right coronary artery sinus or rarely all are originating from single sinus or ending in the same artery. In some an anastomatic network of small arterial branches is found connecting the large vessels indirectly. We tried in answering the questions of anomalous origin of coronary arteries and then describe in detail their vascular relation with normal coronary artery anatomy, lesion’s site, severity, and percentage of stenosis and left ventricular function. In all of our cases, we observed anastomotic networks of various sizes. We found only 22 anomalous arteries out of 500 normal hearts (04%). Similar percentages ranging between 01% and 04% have been reported in the literature, in different coronary angiographic studies On the other hand, in anatomical studies, the percentage ranged between 03% and 5.6 %. We believe that these percentages probably included cases with a large anastomotic network. It is hard to explain why other authors did not report any percentages in their studies. Our results, in accordance with previous publications, clearly demonstrate that anomalous coronary artery does not have a standard point of origin. In our 22 cases, anomalous artery was found directly originating from anomalous sites. The work in all 500 cases, shows the connection of coronary arteries directly or indirectly the proximal and distal parts of the large coronary arteries. These types of connections of the arteries have been described in most of the studies. In this study, we tried to resolve the confusion in the literature regarding the origin of anomalous coronary arteries, there relationship with normal coronary artery anatomy, type of the lesions, site, severity, and left ventricular function. In conclusion, an anomalous artery plays an important role in management of the patients. Also its relation with normal anatomic network, size of vessel, site, percentage & number of lesions, LV functions, dominance of an artery all play very important role in patient’s management. The normal coronary artery anatomy, their relationship, origin, site, number and sizes of lesions and association with left ventricular function are also needed to address.

PROSPECTIVE CORONARY CATHETERIZATION REGISTRY DATABASE AT KARACHI INSTITUTE OF HEART DISEASES, KARACHI; NON-AVAILABILITY OF HUGE FUNDING IS NOT AN ISSUE
JAVED ISMAIL, JUNAID ALAM ANSARI, MIRZA YOUSUF BAIG, GHULAM ISHAQ KHAN, ATIF ZAFAR, FARHAN ULHAQ, ABDUS SAMMAD Karachi Institute of Heart Diseases, F.B. Area, Karachi BACKGROUND: Cardiac Catheterization is one of the most commonly performed major invasive procedures throughout the world. A database in any hospital helps in organizing the patient’s data. This information has significant importance in data analysis. In western world the culture of electronic database registry has established its usefulness as exemplified by NCDR Cath PCI Registry of ACC Foundation. In Karachi Institute of Heart Diseases (KIHD) Angiography and Angioplasty has been performed on 7634 and 920 patients, respectively since year 2005–2009. OBJECTIVE: To establish an Electronic Hospital Database for cardiac catheterization patients with minimum amount of budget in a public sector hospital of Pakistan. METHOD: Registry enroll patients who had their PCI at KIHD from December 2009. A structured questionnaire was developed, with the help of intervention cardiologist, and epidemiologist at KIHD. The questionnaire gather baseline information of the patient, from different stages of PCI and Follow-ups, which are scheduled after One week and then after every 3rd month. The questionnaire contains information on variables, like socio-demographic, detailed patient’s history including comorbids with in-depth cardiac history, physical review and examination, provisional diagnosis, investigation reports and PCI specific information. After filling questionnaire, a registration card containing date for the next follow up was issued to the patient. Participating patients are reminded by phone calls for their upcoming follow-ups. Simultaneously old patients up to June 2009 were also included in the database by inviting them on Phone for a followup. All patients are being provided with a free Clinical Examination, BP recording, Weight, Height and Cholesterol measurement at the time of follow-up. Data is entered in Epidata software by a trained data entry operator. All of the volunteers, research coordinators, research associate, data entry operator, and staff were trained by a Principal investigator. The registry was established with the meager amount of around PK Rs.30,000, which was mainly utilized for communication charges, printing of questionnaires, and purchase of some basic equipment like bath room weighing scale, wire less telephone, printing papers etc. CONCLUSION: In western world the presence of database in Hospital setup has helped in monitoring the overall progress of patient. Hence by introducing this database in Karachi Institute of Heart Diseases, Karachi, will help us in monitoring the patient’s outcome undergoing PCI, quality of management according to the current guidelines, and carry out researches. We would also like to emphasize that a quality data base can be established with meager amount of funding, and volunteer participation.

CORONARY ARTERIES OCCLUSION SITES AND LEFT VENTRICULAR DYSFUNCTION IN PATIENTS VISITING KARACHI INSTITUTE OF HEART DISEASES
JAVED ISMAIL, FAREENA KHAN, MAHA MOHSIN, SYEDA TAHIRA NARJIS, GHULAM ISHAQ KHAN, JUNAID ALAM ANSARI, MIRZA YOUSUF BAIG, ABDUS SAMMAD Karachi Institute of Heart Diseases, F.B. Area, Karachi INTROCDUCTION: Coronary vascular disease is one of the leading causes of mortality world-wide. It is estimated that around 262.5 per 100,000 deaths have been caused Cardiovascular diseases in general, out of this 7.6 million people are dead only due to Coronary artery diseases. Coronary Angiography is diagnostic tool for the coronary vessel disease which allows us to measure the extent and severity of atherosclerotic disease. Therefore the findings of this diagnostic tool have immense importance in the prognosis of CAD and further management of the patient. OBJECTIVE: To find out the age related blockage of different locations of coronary vessels with the help of coronary angiography. METHOD: A cross-sectional study based on angiographic data of Karachi Institute of Heart Diseases. We conducted a retrospective analysis of angiographic findings in patient’s data present in the computer from May 2009 till August 2009. The permission to use the data was granted by administration of KIHD. RESULT: Angiographic results of total 405 patients, admitted in KIHD for their angiography, were entered from their records. There were 76.8% male, and mean age (±SD) of the patients was 50 years (± 8.82). Middle portion of the LAD was the most occluded area in our study subject, which was occluded in 62.7%, whereas proximal and distal areas were occluded in 40% and 20.5%, respectively. Middle portion of RCA was occluded in 39%, and proximal LCX, proximal RCA, Middle LCX, was occluded in 38.5%, 33.6%, and 29%, respectively. Left main coronary artery was occluded only in 8.9% of patients, with least occluded area of proximal part, 0.9%. LAD was occluded in 43.9%, RCA 33.08%, LCX 29.21, and LM in only 3.05% of the patients. Right Coronary artery was dominant in 47%, whereas LCX was dominant in 15.1% of the patients. Majority of the patients had Triple Vessels Disease, 39.25%, whereas 28.9% and 19.25% had double vessels and single vessel disease. Normal vessels were diagnosed in 12.6% of patients. Majority of the patients had normal LV function, 67.7%, whereas 24.47% of the patients had moderate to severe LV dysfunction, and 7.81% suffered from mild LV dysfunction. CABG was advised in 29.1%, PCI in 22%, medical management in 47%, and thallium scan in 3.2% of the patients. CONCLUSION: Results showed that our study population had coronary artery disease at younger ages as compared to the western populations. Majority of the patients suffered from LAD coronary artery occlusion, which supplies the anterior major force generating part of the heart. Major occlusion at anterior part indirectly shows the severity of the diseases, and higher degree of morbidity, with restriction to heavy physical activity. The severity of the disease is further validated by the observation that majority of our study patients had triple vessels disease, followed by double vessel and single vessel diseases. Majority of our study subjects were advised to undergo CABG, which in turn is relatively a very costly procedure, as majority of the population consulting KIHD belong to low or middle income group of the society. Our study indicates that majority of our patients had normal LV function, if we focus on our secondary preventive strategies to maintain the normal LV function of these patients we would be in a better position to reduce the mortality, and can delay the serious complications.

coronary heart disease and therefore healthy lifestyles should be encouraged from childhood and preventive measures should be adopted against smoking. KEY WORDS: Coronary heart disease, young adults, old adults, Pakistanis

SIZE OF RADIAL AND ULNAR ARTERY IN LOCAL POPULATION
SULTANA HABIB; TARIQ ASHRAF National Institute of Cardiovascular Diseases, Karachi INTRODUCTION: Trans-radial coronary angiography and angioplasty is becoming more popular for diagnosis and treatment of coronary artery disease. It is now increasingly being utilized as an alternative site of access for cardiac catheterization .Different studies have mentioned diameter of radial & ulnar artery in their population. Our aim was evaluate radial & ulnar artery diameter in patients undergoing diagnostic coronary angiography in our population for its suitability in performing cardiac diagnostic therapeutic interventions. MATERIAL AND METHOD: This was a cross-sectional study carried out at National Institute Of Cardiovascular Diseases(NICVD) from February to September 2008.Patients who were advised to undergo coronary angiography via radial artery as first time procedure were included. After written consent before the study right, and left radial and ulnar arteries were screened with Duplex Doppler ultrasonography with a 7.5 MHz probe, Toshiba Power Vision. The smallest internal diameter in each one third segment of the radial and ulnar artery was recorded after comparing the size at both the longitudinal and transverse section. The average diameter of the radial and ulnar artery was used for analysis. Preexisting risk factors for coronary artery disease at the time of ultrasonography were recorded i.e. Gender, diabetes mellitus, hypertension, smoking, height, weight, body surface area(BSA) and body mass index(BMI) RESULTS: Total of 251 patients were included. Their mean age was 51.9+9.8.There were 33.5% diabetics, 31.9%hypertensive, and 57.8%smokersThe mean diameter of right and left radial artery was 2.3 ± 0.4mm and 2.2+ 0.4mm and right and left ulnar artery was 2.4 ± 0.4mm and 2.3 ± 0.3mm, respectively. The factors found to be positively affecting the size of radial artery included sex, diabetes mellitus and smoking. There was no co- relationship of radial and ulnar artery with body size parameters (height, weight, BSA & BMI). CONCLUSION: We concluded that ulnar artery diameter is larger than the radial artery in our population. Ultrasound may be the tool for measuring size of radial before the procedure Knowing the size will guide the interventional cardiologist in using appropriate size sheaths and guiders and for the cardiac surgeons in utilizing radial artery as conduits for arterial bypass grafting.

REASONS FOR MEDICAL NON-COMPLIANCE IN HEART FAILURE PATIENTS
DR.S.FAYYAZ MUJTABA, DR. SAAD,DR. DANYAL, DR. DOST MUHAMMAD,DR. TARIQ MASOOD National Institute of Cardiovascular Diseases, Karachi OBJECTIVE: To determine prevalence of non compliance in heart failure patients and frequency of various reasons of non compliance. STUDY DESIGN: Descriptive SETTING AND DURATION: All medical wards of NICVD in 20 days PATIENTS AND METHODS: All the patient already diagnosed and on heart failure treatment admitted in medical wards of nicvd were included in study. After informed consent they were interviewed and a preformed questionnaire filled. Apart from their basic information their education ststus, self caring status and their sense of recognition of prescribed medication were noted. Their compliance level was assessed for individual drug was assessed along with correct dosage and timing. In the end if found non compliant search for their reason was made. RESULTS: Out of 114 patients 62 were male and 52 were female.40 educated and 74 non educated.61 self caring and 53 were other were taken care by otherd.46 could recognize medication and 68 cannot.33 were compliant and 83 noncompliant CONCLUSION: About 70% of the patients were found non compliant. Educated and self caring were found moiré compliant than non educated and when other were care giver. 14% reason was inadequate prescription, 13% due to lack of counseling and follow up 12% were non compliant due to financial reasons.13% stopped medication because thy didn’t feel need as they were symptomatically stable

COMPARISON OF RISK FACTORS OF CORONARY HEART DISEASE IN YOUNG INDIVIDUALS AS COMPARED TO OLDER PEOPLE AT AFIC RAWALPINDI
DR SIDRAH FAROOQ, DR ALI NAWAZ, BRIG DILSHAD AHMED, DR SAIRA SHABBIR OBJECTIVE: In this study we aimed to examine the angiographic findings, traditional risk factors and natural history of Pakistani patients <45 and >45 years old with coronary heart disease (CHD). METHODS: The records of 195 patients with Myocardial Infarction, who had undergone coronary angiography were reviewed. The patients <45 years (group 1) and >45 years (group 2) were compared. RESULTS: The study population was classified as group 1 with 73 patients (mean age 38.75±4.68) and group 2 with 122 patients (mean age58.3±7.56). Smoking, family history, military occupation and Punjabi ethnicity were more prevalent in group 1 while diabetes mellitus, hypertension, pathan ethnicity and increased waist circumference were higher in group 2. Patients in group 1 showed a preponderance of single-vessel disease whereas patients of group 2 showed dominance of multi-vessel disease. CONCLUSION: Our study shows a significantly different clinical and angiographic profile in <45 years patients with coronary heart disease compared with >45 years patients. Smoking is an important preventable risk factor in premature

PROGNOSTIC VALUE OF NORMAL EXERCISE 99mTC-SESTAMIBI MYOCARDIAL PERFUSION IMAGING IN PAKISTANI POPULATION
HASAN RAZA, SUMAIRA MUSHTAQ, SHAHID KAMAL, SHAHEEN ZAREEN, MINHAJ MAQBOOL, BASHIR AHMED, NAJMUDDIN, ZAFAR NASIR, RAHEELA MEHMOOD, M. EJAZ, RUKHSANA MEMON Atomic Energy Medical Centre Jinnah Postgraduate Medical Centre, Karachi BACKGROUND: Previous studies have documented the prognostic value of normal exercise myocardial perfusion imaging in patients with no known coronary artery disease (CAD). The purpose of this study was to investigate the prognostic value of normal exercise Tc-sestamibi SPECT in Pakistani patients with no known ischemic heart disease. METHODS: 137 clinically suspected ischemic heart disease patients who underwent 99mTc-MIBI stress-rest Myocardial Perfusion SPECT (MPS) were followed up for 27 +/- 3 months after the scan about cardiac death and myocardial infarct (hard events). They were divided into two groups according to their pretest probabilities for CAD. RESULTS: Two patients were lost to follow up, rest showed an excellent survival rate with hard cardiac event rate of 0.74%. However there was statistically nonsignificant difference between the survival rates of low and high pre-test probability groups. CONCLUSION: Study demonstrated good prognosis for patients with normal exercise myocardial perfusion scan.

OBJECTIVE: The primary objective of the study was to compare the efficacy of two anti-TB regimens in terms of sputum conversion an the end of intensive phase and treatment success rate MATERIAL AND METHOD: It was a retrospective analysis. Documents used were data entered in Tb 03 registers of 3rd and 4th quarter in of 1997 and 1st and 2nd quarter of 1998 was compared with the data entered in 3rd and 4th quarter of 2007 and1st and 2nd quarter of 2008 and Quarterly reports of case finding Tb07, sputum conversion Tb 08 and treatment out come Tb 09 RESULTS: Total number of smear positive case in intermittent therapy group was 702 in daily therapy group was 1120. Male to female ratio showed no significant change. There was no significant change in pattern of age distribution. Sputum conversion at end of intensive phase was achieved in 582 out of 702(83%) in intermittent therapy and 896 out of 1120 (80%) in daily therapy group.Success rate 78.83 % in intermittent therapy and 78% in daily therapy group Default rate was 20.51 in intermittent therapy in 1997-8 and 13% in daily therapy group 10 years later. No of serious adverse event was reported with intermittent therapy. Itching in 2(2.8%), jaundice in 3 (4.2%) and vomiting in 7(9.9%) patient in intermittent therapy. Relapse was observed in 1.2% patients after one year follow up. Total number of visits for DOTs required by DOTS’ supporter are 66 for daily regimen and for intermittent therapy are 36 almost 46% less for category 1 cases. Total cost of medicine is 33% less in intermittent therapy for category 1 cases. CONCLUSION: TB control program has achieved 100% DOTS coverage in the public sector is not far in achieving the target of treatment success rate in new pulmonary TB case. However it is struggling to reduce the default rate. This can be reduced by strong net work of DOTs supporters (persons who see that every dose is supervised). Introduction of intermittent regimen can reduce the number of visits so a person can supervise more patients with lesser effort. It will be advantageous to introduce this regimen in areas where population is thin and accessibility is difficult due to less developed roads.

5-AZACYTIDINE AND ZEBULARINE ENHANCE CARDIOMYOGENIC POTENTIAL OF RAT BONE MARROW MESENCHYMAL STEM CELLS IN VITRO
NADIA NAEEM, KANWAL HANEEF, HANA’A IQBAL AND ASMAT SALIM Dr. Panjwani Center for Molecular Medicine & Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi {Email: salimasmat@yahoo.com; asmat.salim@iccs.edu} INTRODUCTION: Mesenchymal stem cells have generated a great deal of interest because of their potential use in the regenerative medicine and tissue engineering. Mesenchymal stem cells can be converted into beating myocytes after the treatment of 5-azacytidine (a DNA-demethylating agent). METHODS: In the present study, rat mesenchymal stem cells were treated with DNA-demethylating agents, 5-azacytidine and zebularine. The optimized concentrations of these compounds were added into the culture medium and the RNA was analyzed for specific cardiac proteins through RT-PCR. RESULTS: We have found expressions of GATA4, NKX2.5 and Cardiac Troponin T in the treated mesenchymal stem cells. CONCLUSION: We therefore, conclude that pre-treating autologous mesenchymal stem cells with either 5-azacytidine or zebularine before transplantation may increase the likelihood of successful regeneration of damaged myocardium. to emphasize that a quality data base can be established with meager amount of funding, and volunteer participation.

TO DETERMINE THE FREQUENCY OF DEPRESSION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) PATIENTS
DR. FAKHIR RAZA, DR.NADEEM RIZVI Department of Chest Medicine Jinnah Postgraduate Medical Centre, Karachi {E-mail: fakhir12@yahoo.com} METHODS: We conducted cross sectional study between June 2008 to April 2009 in department of medicine, Jinnah hospital Karachi. The sample size of the study was (n=63). All adult patients of presenting with sign and symptoms of COPD confirmed by GOLD criteria giving informed consent following inclusion and exclusion criteria were consecutively included. The primary outcome of the study was prevalence of depression measured through Hamilton Depression Rating Scale (HAM-D). The score was classified into 10-13= mild; 14-17= moderate and >17 = severe. RESULTS: The mean age of the sample was 60.87±10.93 years. There were 50 (80%) males and13 (20%) females. The severity of COPD was 6 (9.523%) patients were mild, 22 (35.02) moderate, 27 (42.90) severe and 8 (12.70%) were very severe. The mild to moderate depression was found in 10 (15%) of patients. CONCLUSION: Our study found the prevalence of depression in10 (15%) of COPD patients It is lower than what international studies have shown. We recommend that all COPD patients would be also screened for depression in order to reduce the morbidity associated with depression and COPD.

COMPARISON OF DAILY VERSUS PARTIALLY INTERMITTENT REGIMEN OF ATT (ETHAMBUTOL, PYRAZINAMIDE, INH, RIFAMPICIN) IN NON HIV WITH NEWPULMONARY TUBERCULOSIS (TB) IN DOTS PROGRAM
DR. SHAHINA QAYYUM, DR IFTEKHAR AHMED, DR GHAZALA ANSARI Ojha institute of chest diseases Karachi {E-mail: imshahina@yahoo.com} INTRODUCTION: Intermittent regimens can be as effective as daily regimens, and it has the advantage of convenient in directly observed treatment, was reported in 1964. Intermittent regimens are considered essential for ambulatory programs. They have been widely explored over the past 30 years. Isoniazid, rifampicin, pyrazinamide, and streptomycin are efficacious when given intermittently (two or three times per week), as when given daily, and ethambutol is usually only given intermittently when also given with rifampin (Such regimens have now been widely used, DOTS strategy was piloted at Ojha Institute of Chest Diseases in april1995. In 1997- 98 a three times a week intermittent regimen was introduced at two major out door clinics of Ojha Institute of Chest Diseases. When the nation wide DOTS program was implemented daily regimen was adopted as recommended by national tuberculosis program in all units of Ojha Institute of Chest Diseases. The study was done to compare the efficacy of intermittent regimen given in 1997-8 with daily regimen as being administered in same clinics ten years later 2007-8.

INITIAL DEFAULT OF PULMONARY TUBERCULOSIS PATIENTS IN A CHEST CLINIC IN KARACHI
DR. NISAR RAO Department of Pulmonology Ojha Institute of Chest Diseases, Karachi {E-mail: nisar.rao@aku.edu} BACK GROUND: ‘Initial default’ is the terminology used to describe diagnosed tuberculosis patients who default before initiation of anti-tuberculosis treatment. OBJECTIVE: To assess the magnitude & reasons of initial default among smear positive pulmonary tuberculosis patients diagnosed at Nazimabad Chest Clinic, Ojha Institute of Chest Diseases, Karachi. METHODS: Prospective study, conducted from 1st December 2007 to 30th April 2008. From the laboratory register we prepared the list of sputum smear positive tuberculosis patients. Then the list was counterchecked with ‘District TB register’ and those who did not report for treatment initiation were labeled as ‘initial default’. They were then contacted on phone number which was provided at the time of

registration. They were informed of the diagnosis and asked to get themselves registered for the treatment. Patients, who registered at the clinic, were asked about reasons for not reporting. RESULTS: Out of 869 tuberculosis suspects, 224 were diagnosed as smear positive pulmonary tuberculosis cases. Out of 224, one hundred sixty-two get themselves registered for treatment. The remaining 62/224 (27.67%) was initial defaulters. On telephonic contact, 55 (88.70%) were traceable while 07/62 (11.29%) was Untraceable-default. Twenty-four patients (38.70%) reported to the clinic and they were registered for treatment. The most common reason for default was ‘dissatisfaction with services at the clinic’. CONCLUSION: The high initial default is a serious issue in the control of tuberculosis and it needs to be addressed urgently.

8 patients, Empyma in 3 patients, lymphoma in1 patient, no pleura in 12 patients. While pleuroscopy of same group of patients showed TB 17 patients, Adenocarcenoma in 21 patients, non specific inflammation in 8 patients, empyma in 3 patients, lymphoma in 1 patient ,no pleura in 3 patients. CONCLUSION: Pleuroscopy is a new and safer diagnostic tool with diagnostic yield upto 93%. Therefore it should be used for diagnosis of undiagnosed cases of pleural effusion.

A TYPICAL PATHOGENS IN ADULTS WITH COMMUNITYACQUIRED PNEUMONIA IN PAKISTAN
DR. NADIA SHARIF ALI BIN SARWAR ZUBAIRI, AFIA ZAFAR, SHAHAN WAHEED, SULEMAN HAQUE, JAVED HUSAIN, JAVAID KHAN Section of Pulmonary & Critical Care, Department of Medicine, Aga Khan University, Karachi {E-mail: javaid.khan@aku.edu} OBJECTIVE: The knowledge of microbial etiology of community-acquired pneumonia (CAP) is limited from Pakistan. The objective of our study was to determine the etiology of CAP and the prevalence of atypical pathogens in patients presenting to the largest tertiary care center in Pakistan. PATIENTS AND METHODS: A single center prospective study was conducted at the Aga Khan University Hospital in all patients age 14 and above who presented with CAP. Clinical data and specimens were collected for a period of 1 year (February 2007-March 2008). For pyogenic bacteria, specimens were submitted for culture and sensitivity. The diagnosis of atypical pneumonia was made using serologic methods to detect antibodies for Mycoplasma pneumoniae and Chlamydia pneumoniae and urinary antigen for Legionella pneumophila serogroup 1. RESULTS: Among 124 recruited patients, 69 (55.6%) males and 55 (44.4%) females mean age was 56 ± 20 years. Mycoplasma pneumoniae 21 (17%) was the leading cause of illness, followed by Chlamydia pneumoniae 15 (12%). There were no cases of Legionella pneumophila serogroup 1. Streptococcus pneumoniae 9 (7.2%) was the most common cause of bacteremic pneumonia. Haemophilus influenzae and Streptococcus pneumoniae were grown from sputum of two patients 2 (1.6%each) and Klebsiella pneumoniae from one. CONCLUSION: Atypical pathogens like Mycoplasma pneumoniae and Chlamydia pneumoniae play a significant role in CAP in Pakistan.

TOBACCO CESSATION TREATMENT: KNOWLEDGE, ATTITUDE AND PRACTICE OF PHYSICIAN IN KARACHI
DR FAROOQ OIGHUR MUHAMMAD IRFAN, HAQUE AS, M NAEEM, KHAN JA. Section of Pulmonary & Critical Care, Department of Medicine Aga Khan University, Karachi {E-mail: javaid.khan@aku.edu} Intervention by physician increases tobacco cessation rates. Assessment of their knowledge, attitudes and practices are fundamental in implementing effective cessation strategies. OBJECTIVE: To asses knowledge, attitude and practice of physician of Karachi for tobacco cessation treatment METHODS: A prospective cross-sectional questionnaire based study recruiting practicing physicians from Karachi. A 19 item questionnaire, which included six items each on attitudes and practice and seven on knowledge, was selfadministered. RESULTS: One hundred and four physicians participated. 89 (85%) were men. There was strong agreement amongst physicians regarding the perception of tobacco use negatively impacting health outcomes 89 (88%) and their role in discussing the issue with the patients 92 (88%). Physicians reported moderate to low levels of comfort in discussing cessation 62 (59%), developing tobacco cessation plan 3 8(36%) and recommending pharmacological treatment 30 (28%). Self assessed knowledge of pharmacotherapy was judged by 56 (53%) to be very good/ excellent. However, on objective knowledge assessment only 6 (6%) physicians were able to correctly answer all items. With regards to practices, 79 (76%) reported that they identified tobacco use status in every patient; with most 73 (70%) advising the users “almost always/always” to quit. CONCLUSION: Most physicians recognize the seriousness of the problem associated with tobacco use and the need to address it. However, significant gaps were identified in physician’s skills, objective knowledge and effective methods in tobacco cessation treatment. There is a pressing need to enhance physicians’ capacity to deal with tobacco related issues.

TO ASSESS EFFECTIVENESS OF BIPAP IN COPD PATIENTS WITH TYPE II RESPIRATORY FAILURE WITH DECREASED CONSCIOUS LEVEL
DR. NOUREEN HANIF, PROF NADEEM RIZVI. Department of Thoracic Medicine Jinnah Postgraduate Medical Centre, Karachi {E-mail: murtaza1999@yahoo.com} BACKGROUND: Noninvasive positive pressure ventilation (NPPV) became a routine method of treatment of acute exacerbation of COPD with type II respiratory failure. Hypercapnic coma secondary to acute type II respiratory failure in COPD is considered to be a contraindication to the use of treatment with Noninvasive positive pressure ventilation (NPPV). However, intubation exposes these patients to the risk of complications such as nosocomial pneumonia, sepsis and even death. MATERIAL AND METHODS: This is descriptive case series study. Data was collected from Chronic obstructive Pulmonary Disease Patients of Type II Respiratory failure with GCS =8 came to emergency and admitted in ICU of chest ward JPMC,. Patients were given Bi-level positive airway pressure (BiPAP) along with standard treatment of COPD. The patients were monitored in the ICU and effectiveness was measured in terms of avoidance of endotracheal intubation, consciousness (GCS 15) and normal respiratory rate (14-18 breath/ min). RESULTS. Total of 30 patients included in the study with decreased conscious level .Most of them responded well with the use of Noninvasive positive pressure ventilation. Detail results shown in presentation. CONCLUSION: We conclude that NPPV found to be safe and effective in patients with hpercapnic coma in typeII respiratory failure secondary to COPD.

COMPARISON OF PLEUORSCOPY AND ABRAMS BIOPSY IN THE DIAGNOSIS OF EXUDATIVE PLEURAL EFFUSION
RABIA AAMIR, NAUSHEEN AHMED, PROF NADEEM RIZVI Department of Thoracic Medicine Jinnah Postgraduate Medical Centre, Karachi {E-mail: dr_aamir79@hotmail.com} INTRODUCTION: Medical thoracoscopy/ Pleuroscopy is a minimally invasive procedure that allows: Access to the pleural space For basic diagnostic procedure i.e. undiagnosed pleural effusion or pleural thickening. For therapeutic procedure i.e. pleurodesis. MATERIAL AND METHODS: In this prospective cross sectional study, closed pleural biopsy using Abrams needle immediately followed by pleuroscopy with a flexible fiberoptic pleuro scope was performed from the same incision in a total of 52 patients ,36 (62%)were male and 16 ( 31%) were female with age ranges from 15-80years, mean age was 44 years. All tissue samples took for biopsies were sent for histopathology. RESULTS: All of the patients in this study underwent Abrams biopsy and pleuroscopic biopsy as well; out of these 52 patients, Abram’s biopsy showed TB in 13 patients, Adenocarcinoma in 15 patients, non specific inflammation in

THE INFLUENCE OF AGE AND GENDER ON PROPER USE OF METERED DOSE INHALER
DR. BABAR DILDAR MUHAMMAD NAEEM, AHMED SULEMAN HAQUE, MUHAMMAD IRFAN, JAVAID A KHAN Section of Pulmonary & Critical Care, Department of Medicine, Aga Khan University, Karachi {E-mail: javaid.khan@aku.edu} BACKGROUND: Inhaled therapy remains the most effective and important aspect of asthma maintenance treatment for patients of all ages. Therapeutic benefit depends on a competent inhaler technique. Many older patients have been shown to have poor inhaler technique. This might be a factor contributing to the observation that death rates from asthma have not fallen in the older age group. We conducted this study to assess influence of age & gender on proper use of Metered Dose Inhaler. SETTING: Chest clinic of Aga Khan University Hospital, a tertiary care teaching hospital in Karachi, Pakistan. OBJECTIVES: To assess the influence of age & gender on proper use of Metered Dose Inhaler in patients with bronchial asthma. METHODS: This was a cross sectional survey. 202 diagnosed asthma patients using inhaler for =6 months were studied prospectively. Patients underwent a questionnaire-based interview, medical records review & direct observation of inhaler technique. RESULTS: There were total 202 patients. 106 (52.5%) patients were female. Mean age ± SD of all patients was 49.41 ± 17.9 years. Mean age ± SD of female & male patients was 48.78 ± 17.8 & 50.10 ± 18.0 years respectively. 98 (48.5%) patients were using inhaler with spacer device. Out of all patients 130 (71.8%) patients self-perceived their inhaler technique as being appropriate. Of 96 men, 18 (18.75%) were using a MDI+spacer & 10 (10.4%) without a spacer correctly. Among females 20 (18.8%) with MDI+spacer and 12 (11.3%) without a spacer demonstrated correct inhalation technique. Among the 98 patients who were using a spacer, the correct technique by age groups was shown by 6 (42.8%) in the <30years, 19 (35.38%) in those between 31-60years & 12 (40%) in >60 years. Among patients using inhaler without spacer the correct technique by age groups was shown by 5 (20%) in the <30, 13 (22.80%) in those between 31-60 years & 4 (18.18%) in >60 years. CONCLUSION: Self perceived inhalation technique is inaccurate in a vast majority our patients. On assessment only one fourth of the patients were found to be acceptable. No significant influence of age and gender was found on correct inhaler technique. Reassurance and checking on each visit can improve the inhaler technique.

pressure. The study recommends a need for measuring blood pressure in children during health maintenance visits. KEY WORDS: Pediatrics, Hypertension, Body mass index.

ANTHROPOMETRIC MEASUREMENTS OF NEWBORNS IN URBAN KARACHI POPULATION
KASHIF ABBAS Pediatric Department Liaquat National Hospital, Karachi OBJECTIVE: To find out the mean birth weight, mean birth length and mean head-circumference and to find out association between income of the family and mean birth weight. METHODOLOGY: This study was done in the Pediatric Department of Liaquat National Hospital from March 2003 to September 2003. Hundred full terms, normal, singleton newborn babies were included and birth weight, length and head circumference were taken within 72 hours of birth. RESULTS: Overall mean birth weight was 2.890 kg, mean birth length 48.245cm and mean head circumference 34.232 cm. The LBW babies were 13%. The mean birth weight of babies belonging to group A (born to families with income >5000 Rupees/month) was 3.044 Kg and that of group B (born to families with income <5000 Rupees/month) was 2.736 Kg. Group A had 8% LBW babies whereas group B had 18 %. Mean birth weight, length and head circumference of boys was 2.961kg, 48.776 cm and 34.316cm respectively. Mean birth weight, length and head circumference of girls was 2.788 Kg, 47.480 cm and 34.109 cm respectively. CONCLUSIONS: It is recommended that community based studies should be conducted from time to time in order to develop our own population data. KEY WORDS: Anthropometrics, Children, Urban areas.

PENILE TOURNIQUET SYNDROME
SYED MUHAMMAD RAEES TAQVI, MUHAMMAD SAJJAD ASHRAF, JAVED AHMED, MUHAMMAD SHAHAB ATHAR, MUHAMMAD TALAT MEHMOOD. Department of Pediatric Surgery Dow University Of Health Sciences, Karachi OBJECTIVE: To find out clinical presentation and outcome of penile tourniquet syndrome. METHODOLOGY: It was a descriptive study conducted at pediatric surgery department of Civil Hospital and DUHS Karachi, from January 2005 to December 2009. Data of all the patients admitted with penile tourniquet injury were reviewed with special reference to the encircling object, nature of the damage andÊ their management. RESULTS: A total number of fifteen cases of penile tourniquet injury were found. Patient’s age ranged from 11 months to 10 years. In 10 cases parents did not know how the encirclement occurred.Ê Four cases were iatrogenic, and in one case thread was tied by the child himself. Out of 15 cases, hair was found as an encircling object in 10, post circumcision bandage in three and one case each of plastibell and kite thread. Mild penile injury (swollen, inflamed tissue) was found in 6 cases, while 9 cases had urethral injury (urethrocutaneous fistula 6, complete urethral transaction 2, and urethral stricture 1). Cases of mild penile injury were managed by removing the encircling objects and local wound management. Urethral repair was done in eight patients and one patient did not turn up for surgery. One patient developed urethral stricture, who responded well on regular dilatation CONCLUSIONS: Penile tourniquet syndrome is an uncommon clinical entity that needs high index of suspicion especially by hair in circumcised pediatric population. Early diagnosis and prompt treatment can prevent severe penile injuries. KEY WORDS: Penile tourniquet syndrome, Children, Penile injury.

BLOOD PRESSURE, BODY MASS INDEX AND WAIST CIRCUMFERENCE OF SCHOOL GOING CHILDREN OF KARACHI
ANJUM SHAHID, AFROZE RAMZAN*, MUHAMAD AYAZ MUSTUFA, SADIA NASIM, ABDUL GHAFFAR PIRZADA, ASHFAQ MEMON PMRC Specialized Research Centre on Child Health & *National Institute of Child Health, Karachi OBJECTIVE: To screen blood pressure, body mass index and waist circumference of school going children in the city of Karachi. METHODOLOGY: A descriptive cross sectional study was conducted on 500 children, comprising of 250 males and 250 females aged 8-14 years from schools of Karachi during the years 2007-2009. Height, weight, waist circumference and blood pressure of each child were recorded. Body mass index was calculated as weight in kilograms divided by height in meters squared. RESULTS: Hypertension i.e. SBP and DBP (=95th percentile) was found in 4.2 and 5.6 % children. With increasing BMI status there was an increase in both systolic and diastolic blood pressure. Over weight (systolic: 107. ±9, diastolic 64.3 ±11.5) and obese (systolic: 108 ± 8.3, diastolic: 68 ±10.7) children had higher blood pressure values than children with healthy weight (systolic: 98.94±9.4, diastolic: 53.3±13.5). This association was present in overall and in males and females. Means of SBP and DBP in obesity and overweight were significantly (p< 0.001) higher than healthy weight. In the obese category, about 9% children were hypertensive (SBP and DBP =95th percentile) and 6.6% (SBP) and12.2% (DBP) were pre-hypertensive (>=90<95) while over weight was marked by hypertension in 7.3% and pre-hypertension in 12.2%.Waist circumference = 90th percentile was found in all obese children, followed by 87.8% in overweight. CONCLUSIONS: Present findings are in accordance with the definition that 5% of children in any given population would be classified as having high blood

SCOPE OF PERCUTANEOUS CATHETER INTERVENTIONS IN CHILDREN WITH HEART DISEASES
NAJMA PATEL Pediatric Cardiology National Institute of Cardiovascular Diseases, Karachi In this era of percutaneous interventions, question arises that how many of those who are suffering from congenital or acquired cardiac lesions can be treated by this modality. There is a long list lesions which can be treated by this modality. This is the big group and about 50-60%of all the patients who require treatment can be treated by percutaneous method. In NICVD during last five years many of these interventions have been performed. Results of these will be discussed briefly. Main limitations in performing these interventions are lack of financial support and shortage of skilled personnel.

AUDIT OF NEONATAL SURGERY
YAQOOT JAHAN, NASIR SALEEM SADDAL, YOUSUF AZIZ KHAN Department of Paediatric Surgery, Unit A National Institute of Child Health, Karachi OBJECTIVE: To find out pattern of neonatal admission to surgical unit in order to devise improvement strategies in terms of mortality and morbidity. METHODOLOGY: Data of all the neonates admitted to single surgical unit at NICH from January 2009 to December 2009 was analyzed..Ê RESULTS: A total 177 neonates were admitted to surgical unit in one year period. A total of 154 neonates underwent surgery. Twenty three patients died before any surgical procedure being performed. Number of patients with anorectal malformations were 54. Four patients expired before any surgical procedure. Thirty eight patients went for colostomy and anoplasty was performed in 14 cases. Total number of neonates with oesophageal atresia with TEF was 28. Four patients expired before any surgical procedure. Definitive surgical procedure was performed in 24 patients of whom 12 died post operatively. Total number of neonates with diagnosis of intestinal obstruction was 51. Five expired before surgery. Intestinal obstruction due to gut atresia was fpund in 24. Intestinal obstruction due to meconium ileus was present in nine. Obstruction due to malrotation in one and annular pancreas in two cases. Neonates diagnosed as Hirschsprung’s diease were 15. Neonates with anterior abdominal wall defects were 20. CONCLUSIONS: This audit revealed survival of 87% after surgery. It has an important message that earlier recognition and referral of these anomalies, availability of neonatal intensive care services can improve survival even further. KEY WORDS: Neonates, Audit, Mortality.

CYTOGENETICS LAB AT NATIONAL INSTITUTE OF CHILD HEALTH: IT’S VALUE TO PATIENTS AND PHYSICIANS.
NIZAM UL HASAN President of Child Aid Association National Institute of Child Health, Karachi Human cytogenetics has opened avenues for diagnosing and monitoring many diseases which at times are difficult to diagnose on clinical grounds and other laboratory tests available. Only four cytogenetics laboratories are functioning in Pakistan one of these is at the NICH. Prior to the start of this laboratory only those patients who could pay for test at private facility were the lucky ones. At the NICH lab the facilities for oncology patients is free and other patients of NICH get these tests done free or at affordable cost thus making it available to underprivileged patients. Results of two years working of the cytogenetics lab at NICH will be presented.

DOES PROPHYLACTIC USE OF DEXAMETHASONE HAS A ROLE IN REDUCING POST-EXTUBATION STRIDOR AND RE-INTUBATION IN CHILDREN?
ALI FAISAL SALEEM, SURRIAYA BANO, ANWAR-UL-HAQ Department of Pediatrics and Child health, The Aga Khan University Hospital, Karachi {E-mail: ali.saleem@aku.edu} OBJECTIVE: To determine the role of dexamethasone (DEX) in postextubation stridor (PS) frequency and reintubation rate in critically ill infants and children METHODOLOGY: This study was conducted in a pediatric intensive care unit. This was a retrospective case-control study. All children aged from 4 weeks to <5 year who were intubated for at least 48 hours (n=51) during 6 months were included. Data of the patients treated with DEX (0.5 ml/kg every 6 hours for 3 doses, beginning 6-12 hours prior to extubation) (n=30) were compared with control patients (who had not received medication) (n=21). RESULTS: The DEX and control groups were similar in age i.e., mean ages of DEX group were 16.85±14 months, and that of control group were 19.02 ± 19 months. Mean duration of intubation and mechanical ventilation in DEX group was 5.17 ± 4.58 days, and that in control group was 3.98 ± 3.60 days. There was no significant difference between DEX and control group in the incidence of postextubation stridor [17% (5/30) vs. 10% (2/21); p = 0.5, OR (0.5)] and the reintubation rate [7% (2/30) vs. 10% (2/21); p = 0.7, OR (1.7)]. CONCLUSION: Prophylactic use of dexamethasone in planned extubation of children was controversial and unwarranted. KEY WORDS: Dexamethasone, Stridor, Re-intubation.

ANEMIA IN CHILDREN WITH CHRONIC KIDNEY DISEASE AT NATIONAL INSTITUTE OF CHILD HEALTH, KARACHI
SADAF ASIM, KHEMCHAND N MOORANI, MICHAEL KHOKHAR Department of Pediatric Nephrology National Institute of Child Health, Karachi OBJECTIVES: To determine the etiology of chronic kidney disease in children and the frequency of anemia in children with CKD. METHODOLOGY: It was descriptive observational study, carried out at Pediatric Nephrology department of National Institute of Child Health. Karachi from January to December 2009. All children of age range from 1mo -15 yrs, diagnosed as CKD were included. Patients were diagnosed as CKD based on clinical assessment and serum creatinine and categorized ÊÊaccording to severity into I-V stages (KDOQI Guide Lines). Urinalysis, CBC, Ultrasound KUB, and other appropriate tests were done to establish cause of CKD.Ê Patients were labeled as anemic if hemoglobin was < 11 G/dl. Iron profile for exclusion of iron deficiency was done with serum Iron, Ferritin, Total Iron Binding Capacity and Transferrin Saturation%. RESULTS: A total of 76 patients with CKD were admitted in ward during study period. Among them 52(68.4 %) were males and 24(31.5 %) were females with M to F ratio of 2:1.The age group of study population ranged fromÊÊ one month to 15 years (mean age 5.4 yrs) .Most commonÊÊ age group was as 1 – 5 years (26/ 34.2 %) followed by children above 5 to 10 years (19/25 %) andÊÊ older than 10 years (15/ 19.73%). Ê Majority of patients were in CKD Stage-III (17/22.3%), IV (18/23.6%)Êand V (19/25 %) suggesting late diagnosis andÊlate referral. Most common etiology of CKDÊwasÊhypoplastic / dysplastic kidney disease (17/22.3 %), followed by urinary calculi (16/21.05%), congenital obstructive uropathies (13/17.10 %), reflux nephropathy (12/15.7%), juvenile nephronophthiasis (J NN 11/ 14.4%) andÊchronic glomerulonephritis (7/S9.2%). Fifty six children (73%) were anemic and among them 34 (60%) had complete iron workup done. Iron deficiency anemia was found in 22 children (64.7%). CONCLUSION: Most common cause of CKD in this study was hypoplastic dysplastic kidney disease followed by urinary calculi and congenital obstructive uropathies. Majority of children were anemic and iron deficiency was responsible for causing anemia in most of children. KEY WORDS: chronic kidney disease, etiology, anemia, children

PAN-RESISTANT ACINETOBACTER INFECTION IN NEONATES IN KARACHI, PAKISTAN
ALI FAISAL SALEEM, IMRAN AHMED, FATIMA MIR, REHAN ALI, ANITA ZAIDI Department of Pediatrics and Child health & Microbiology, Aga Khan University Hospital, Karachi {E-mail: ali.saleem@aku.edu} OBJECTIVE: To find out frequency and mortality associated risk factors in Acinetobacter neonatal infection. METHODOLOGY: This was a chart review of five year period (July 2003 – June 2008) of all neonates hospitalized in our Neonatal Intensive Care Unit and

developed Acinetobacter infection. RESULTS: A total of 122 cultures from 78 neonates grew Acinetobacter. Source sites of positive culture were in the following descending order; blood (n=57), trachea (n=55), tissue/wound/body fluids (n=4), urine (n=1), eye (n=4) and Cerebrospinal fluid (n=1). Twenty four (31%) patients had Acinetobacter isolated from more than one site. At the time of admission the mean age was 2.08 ± 4 days and mean weight 1.77 ± 0.88 Kg, while seventy five percent were premature. Pan-resistance (87/122; sensitive only to Polymyxin) was present in 71% of Acinetobacter isolates. Crude mortality rate of this cohort was 47%, while 70% of patients died within 4 days after their positive Acinetobacter culture. We identified weight <1 kg on admission (p 0.06, adjusted Odds Ratio (AOR) 3.4), poor perfusion (p 0.006, AOR 2.4), thrombocytopenia (p 0.01; AOR 1.8) and metabolic acidosis (p 0.01; AOR 1.75) as predictors associated with poor outcome. CONCLUSIONS: Pan-resistant Acinetobacter infection is exceedingly fatal in newborns, particularly in premature and very low-birth weight neonates. Rationalized antibiotics use and vigilant infection control in intensive care areas is the key to control multi-drug resistant Acinetobacter infection and improve clinical outcome. KEY WORDS: Acinetobacter infection, Neonates, Mortality.

METHOD: All patients undergoing non traditional cardiac surgery utilizing the cardiopulmonary bypass during the year 2009 were reviewed. Their preoperative presentation, operative strategy and immediate postoperative status were assessed. RESULTS: A total of five such cases were identified. There were, three female and two male patients. Two patients presented with road traffic accident having aortic transaction along with other injuries. They under went repair utilizing partial cardiopulmonary bypass. One patient presented with large PDA aneurysm and symptoms related to its pressure effect on respiratory system predominantly. He underwent repair first under partial left heart bypass and then hypothermic circulatory arrest. These three patients were done via left thoracotomy. Two patients underwent deep hypothermic circulatory arrest, one for removal of thrombus from right atrium after complicated liver abscess and hepatic vein thrombosis and other required vascular graft interposition in left internal carotid artery for aneurysm extending into cranium. The former was done with complete sternotomy and later was done with partial sternotomy. One patient required exploration for bleeding. Overall postoperative course was unremarkable and all patients were discharged home. CONCLUSION: Our modest experience highlights the extension of the scope of cardiopulmonary bypass, facilitating to perform complex, technically challenging non cardiac procedures with safety.

SURVEILLANCE FOR POST OPERATIVE WOUND INFECTIONS IN GENERAL SURGERY WARD OF A TERTIARY CARE HOSPITAL OF KARACHI.
SAFIA BIBI, GHULAM ASGHAR CHANNA*, TARANUM RUBA SIDDIQUI, WAQUARUDDIN AHMED Pakistan Medical Research Council, Research Centre, Jinnah Postgraduate Medical Centre, Karachi, *Jinnah Postgraduate Medical Centre, Karachi AIMS: To determine the frequency of post operative wound infections in surgical ward-2 of JPMC and to identify common bacterial pathogens and their sensitivity patterns to commonly prescribed antibiotics. SETTINGS: The study was conducted in the surgical ward of Jinnah Post Graduate Medical Centre, Karachi. METHODS: This was a cross sectional study of one year duration. Sampling was carried out from December, 2008 – November,2009. During the sampling period data was collected for all the patients who underwent surgery in the surgical ward of JPMC. Culture and sensitivity testing was performed only for patients who developed infection according to CDC definition. Data was collected on pre-designed performa which included details about patient’s demographics, type of surgery, prophylactic antibiotic, any co-morbids, wound infection and results of culture and sensitivity testing. Association of Postoperative wound infections (PWI) with different variables was also studied. RESULTS: Total 1120 surgical procedures were performed in the selected ward during the study period, of which 82 (7.3%) patients developed PWI. Age of patient, electivity of procedure, wound class and diabetes were found to be main contributing factors to PWI. Frequency of infection in clean, clean contaminated, contaminated and dirty procedures was 1.5%, 2.5%, 6.5% and 21.4% respectively. Pathogen could be isolated in 52(73.2%) patients. The most commonly isolated pathogens were E.coli (33.8%), Ps. aeruginosa (16.9%) and S. aureus (15.5%). All the E.coli isolates showed 100%, 93%, 32% and 12 % resistance to Ceftriaxone, Ofloxacin, Amikacin and Meropenem respectively. Pseudomonas aeruginosa isolates were 100% resistant to Tetracyclin and Ceftazidime, 91.6% to Ofloxacin, 83.3% to Meropenem and 66.7% to Amikacin. S. aureus exhibited maximum resistance to Cloxacillin(100%) followed by Ofloxacin(90.9%), Tetracyclin(45.5%), Amikacin (45.5%), Chloromphenicol (36.4%) and Vancomycin (0%). CONCLUSION: Frequency of post operative wound infections in surgical ward of JPMC is comparable to other hospitals of Pakistan but is higher as compared to developed countries and NNIS standards. The situation is further worsened by increasing frequency of multidrug resistant (MDR) organisms. Pathogens are continuously acquiring resistance against older and currently used antibiotics which results in problem to control PWI.

THE EFFECT OF RAMADAN FASTING ON DUODENAL ULCER PERFORATION: A RETROSPECTIVE STUDY
DR SHIREEN RAMZANALI DAMANI**, DR SYED SAGHEER HUSSAIN SHAH***, DR ZIA-UL-ISLAM****, DR MASOOD RAZA***** **Trainee MRCS-3 RCSED & Trainee RMO, ****Associate Professor & Head of Department ****Assistant Professor, *****Senior Registrar Surgical Unit-III (Ward 26) Jinnah Postgraduate Medical Centre, Karachi {E-mail: dr_shireenramzanali@yahoo.co.uk INTRODUCTION: Ramadan is the month of barakat for the Muslims all around the world. Ramadan is the 9th lunar month of the Muslim calendar which is obligatory for all healthy Muslims to fast during the day time. OBJECTIVE: The aim of the study is to evaluate the relation between the Ramadan fasting and to assess the risk factors for the peptic ulcer disease in fasting Muslims. DESIGN & SETTINGS: This Retrospective analytical study includes all the patients who underwent surgery (laparotomy) especially in Ramadan for duodenal ulcer perforation in the Accident & Emergency department on the day of call of Surgical Unit III, Ward 26, JPMC, Karachi from 2004 to 2009. METHOD & MATERIAL: Demographic, concomitant diseases & the predisposing factors were analyzed. The comparison were made between the two groups, Group 1 includes those who were operated in the month of Ramadan within 5years period (i.e. 5-month during the study period) and on the remaining period (55 month during the study period ) were included in Group 2 . RESULT: Two hundred and sixty patients were included in the study (60 in group 1 and 200 in group 2). The number of surgeries was higher in group1 than group 2 (12 patients per month in group 1 vs 3.6 patients per month in group 2). CONCLUSION: To recapitulate the incidence of duodenal ulcer perforation is relatively higher in Ramadan among the people who are fasting & has higher predisposing factors especially the history of dyspepsia.

EVOLVING APPROACH TO NEOPLASIA OF THE ESOPHAGUS: OVER A DECADE OF EXPERIENCE
*DR. K.M. INAM PAL, DR. FARRUKH HASAN RIZVI, DR. HASSAN BARI *Associate Professor & Head Section of General Surgery Department of Surgery, Aga Khan University Hospital {Email: inam.pal@aku.edu} The section of GS has been dealing with neoplastic disease of the esophagus since its inception and over the years has acquired substantial expertise in its treatment. We have reviewed our experience of past 13 years and changes in our approach to its treatment. A total of 128 patients were surgically. The mean age of patients was 52 years (range 18-80yrs); 70 males and 58 females. Hundred and thirteen patients underwent a two stage Esophagectomy (Ivor-lewis-tanner) and 15 patients had a 3 stage Esophagectomy; for 92 tumors located in the lower 1/3, thirty two tumors in the middle 1/3 and three tumors in the upper 1/3 of the esophagus. There were 94 Squamous neoplasms, 32 adeno-carcinomas and 2 large cell neoplasms. Twenty three patients were given neoadjuvant treatment. Elementary track reconstruction was with a gastric tube in all patients. A total of 10 anastomotic

EXTENDING THE SCOPE OF CARDIOPULMONARY BYPASS
SYED SHAHABUDDIN, MUNEER AMANULLAH, SAULAT FATIMI, HASANAT SHARIF Cardiothoracic Surgery, Department of surgery Aga Khan University Hospital {E-mail: syed.shahab@aku.edu} INTRODUCTION: Traditionally cardiopulmonary has been used for addressing congenital, valvular and ischemic heart disease. However, owing to technical advancement and increase safety of cardiopulmonary bypass, its uses are stretched for non traditional cases.

leaks were suspected in the post operative period on radiological or clinical grounds. One leak delayed discharge due to sepsis needing prolonged antibiotic treatment and jejunal feeding. Two were significant contributors to patient death. The most common post operative complications were pulmonary and in some form were seen in 30 (23%) patients. Three patients (2%) died due to post operative complications in the 30 day post-operative period. Over the years we have moved away from 3stage esophagectomy and extraanatomic placement of the conduit. We now perform a 2 field lymph node clearance and prefer a single layer continuous suture technique for anastomosis. Our approach to neoadjuvant treatment continues to evolve; this now is offered as a combined modality treatment for locally advanced disease. Conclusion: Surgery plays a central role in treatment of esophageal neoplasms. It is a complex undertaking with a significant incidence of post operative complications. We have acquired significant experience with this procedure over the past decade, our peri-operative results are at par with well established high volume international centers. KEY WORDS: Esophagectomy, Esophageal neoplasm, Anastomotic leak,

the defect; a range of reconstruction techniques have been described. The quality of the residual scalp is critical for performing a local flap. Scalp reconstruction may be difficult in extensive defects and require a medical team when tumours are involved.

TWO-PORT LAPAROSCOPIC CHOLECYSTECTOMY: AN EARLY EXPERIENCE
1S H WAQAR & 2M A ZAHID 1Assistant Professor / 2Professor of Surgery Minimal Access Surgery Unit (MASU), Department of General Surgery Pakistan Institute of Medical Sciences, Islamabad {Email: drshwaqar@gmail.com} Laparoscopic cholecystectomy is the procedure of choice in all the gall bladder diseases and there is increase in the expertise of surgeons with newer equipment. Usually the laparoscopic cholecystectomy is performed by using three or four ports. Two ports laparoscopic cholecystectomy is a rarely performed procedure as it demands greater expertise and skills. Benefits of this technique include being less expensive and less scar forming as compared to the conventional approaches of laparoscopic cholecystectomy. We present a series of eight cases of laparoscopic cholecystectomy performed by using only two ports. KEYWORDS: Laparoscopic cholecystectomy, Gall bladder.

OUTCOME OF RECONSTRUCTIVE PROCEDURES IN FOURNIER`S GANGRENE AT LIAQUAT UNIVERSITY HOSPITAL JAMSHORO
*BILAL FAZAL SHAIKH, PROF. ABDUL RAZAK MEMON, **DR. MAHESH KUMAR *Department of Plastic Surgery and **Department of Plastic & Reconstructive Surgery Liaquat University Hospital, Jamshoro {E-mail: bilalfazal@live.com} OBJECTIVE: To determine the outcome of the reconstructive procedures utilized for the genital area wound following Fournier’s gangrene and their complications in our setup. DESIGN & DURATION: Prospective observational study conducted from January 2005 to December 2008. SETTING: Dept. of Surgery and Dept. of Plastic & Reconstructive Surgery at Liaquat University Hospital, Jamshoro. PATIENTS: A total of 18 patients with Fournier’s gangrene were included in this study. METHODOLOGY: Data was collected through a pre-designed proforma. Initially all the patients were managed in the surgical ward and later on they were shifted to the Plastic Surgery & Reconstructive ward for reconstruction of wound. RESULTS: Split thickness skin graft (SSG) was carried out in 12 cases (66.66%), followed by primary closure in six (33.33%) and medial thigh flaps in two (11.11%) cases. Partial skin loss was seen in six (33.33%) and complete loss in one (5.55%) patient. Diabetes mellitus was the commonest co-morbidity found with Fournier’s gangrene. CONCLUSION: Skin grafting is an easy option with acceptable aesthetic and functional results. Primary closure of the scrotal wound by stretching and expanding is ideal when up to 1/3rd of the residual scrotal skin is available.

INTRACAVITARY DRAINAGE OF GIANT EMPHYSEMATOUS BULLAE IN PATIENTS WITH POOR PULMONARY RESERVE
TANVEER AHMAD, S. WAQAR AHMED & NIAZ HUSSAIN Department of Thoracic Surgery Jinnah Postgraduate Medical Center, Karachi INTRODUCTION: Patients with large emphysematous bullae with poor respiratory reserve present a therapeutic challenge. Thoracotomy for definitive treatment is not without a high risk of mortality. Monaldi introduced a two stage procedure to obliterate the pleural space, drain and collapse these bullae. Later, modifications like the Brompton procedure were introduced for the management of these cases. PURPOSE OF THE STUDY: To evaluate the short and long term results of intracavitary drainage of giant emphysematous bullae in patients with poor respiratory reserve. PATIENTS AND METHODS: All patients had preoperative chest X rays and computed tomography to asses the size of the bulla, pneumothorax if present and laterality. All procedures were done under local anesthesia except one which was done under general anesthesia. Patients’ dyspnea was categorized in grades 0 to V (Hugh-Jones Criteria). A large size Foley’s catheter was used in all cases to drain the bulla. Foley’s catheter was connected to underwater seal. In addition, a size 36 chest drain was used to drain the pleural space when a Brompton procedure was performed. Talc solution was used in 5 patients to obliterate the bulla and achieve pleural symphysis. RESULTS: Twelve patients (8 males and 4 females) underwent a total of thirteen procedures (4 Monaldi procedures and 9 Brompton procedures) over a twelve month period from July 2007 to June 2008. The mean age was 46.4 years (2967 years). Mean size of the bullae was 6.4 cm (5-15cm). The mean preoperative FEV1 and FVC were 0.81l (0.69-1.2l) and 1.9 l (1.0-2.8), respectively. Most bullae were located in the upper lobes (RUL=5, LUL=4, RLL=2 and LLL=2). Symptoms improved (Dyspnea grade V to grade II) with a 40% to 90% improvement in FEV1 and FVC, 2 weeks after the procedure with sustained recovery over the next many months. Chest X rays also showed marked reduction in the size of the bullae and in five (41.7%) cases complete disappearance of the bullae. Drainage continued for a mean of 31 days (25-45 days) before the catheter was removed. Since the improvement in symptoms, three patients have undergone elective thoracotomy with bullectomy. Complications were blocked catheters in 3 patients and subcutaneous emphysema was seen in 2 patients with severe COPD. Three patients (25%) were diagnosed as having tuberculosis and were started on ATT. Recurrance of bullae was seen in 2 patients. There was no mortality in this series. Average duration of surgery was 25 minutes. Follow up of more than 6 months is available for 7 patients. CONCLUSION: It is concluded that intracavitary drainage of giant bullae is a simple, safe, quick and effective treatment of emphysematous bullae in patients considered unfit for a thoracotomy.

MANAGEMENT OF SCALP DEFECTS
DR. MAHESH KUMAR Assistant Professor Department of Plastic & Reconstructive Surgery LUMHS Jamshoro/ Hyderabad BACKGROUND: Large scalp defects can be challenging to repair because of the inelasticity of the scalp. While there are several methods to close this type of wound, they result in either alopecia or unacceptable scarring.Ê AIM: To assess the outcome of treatment options available for reconstruction of scalp. PATIENTS AND METHODS: A Prospective case series conducted at Department of Plastic & Reconstructive Surgery, Liaquat University of Medical & Health Science, Jamshoro from January 2003 to December 2007. 40 cases of scalp reconstruction operated from January 2003 to December 2007 were analyzed. The functional aspects of the reconstruction were reviewed RESULTS: 3 cases (7.5%) of scalp defect were repaired with primary closure; rotation flap was done in 25 cases (625%). S.S.G was done in 9 cases (22.5%), outer table were removed in 2 (5%) cases, and periosteal flap was done in 1 case (2.5%). CONCLUSION: Scalp reconstruction depends on the nature and the region of

INCIDENCE OF CHRONIC POST-OPERATIVE PAIN IN PATIENTS OPERATED FOR INGUINAL HERNIA AND ITS IMPACT ON QUALITY OF LIFE
*DR. SIJAD AHMED & **DR. SUGHRA PARVEEN *Resident / **Assistant Professor Surgical Unit-III Jinnah Postgraduate Medical Centre, Karachi INTRODUCTION: Chronic post-operative pain has emerged as a major postoperative problem after hernia surgery2,4,5,7,8,9,10,15. Incidence of chronic post-operative pain not only causes the discomfort but in severe cases it may limit the abilities to fulfill activities of daily life and professional performance1,2,3,10,17. Pain thus may result in negative social consequences for the patient and family. PATIENTS AND METHODS: PATIENTS: This is a prospective analytical study that was carried out in follow up clinic of surgical unit (III) ward 26, JPMC Karachi. From 15-06-2009 to 1412-2009. All the patients visiting follow up clinic after being operated for inguinal hernia including obstructed and strangulated inguinal hernia were included. METHODS: A questionnaire was formulated that covered all the aspects of study and it was provided to the resident on duty in the follow-up clinic of surgical unit (III) ward 26, JPMC, who was trained to fill in the questionnaire after interviewing the post-operative patients of inguinal hernia, that are meeting inclusion criteria. RESULTS: Out of 45 (n=45) patients 34 (75.6%) reported no or ignorable pain after 3 months of surgery and 11 (24.4%) patients reported the pain that was not ignorable. In 3 (6.7%) patients pain was severe enough to interfere with the routine activities. CONCLUSION: The results of this study emphasize the need of careful steps to control pain among patients undergoing hernia surgery. Establishment of potential risk factors and prevention of post-operative pain in patients undergoing surgery for inguinal hernia are important potential fields of improvement and research.

45 min . There were only 2 conversions into open procedure from group 2 . No major postoperative complications encountered in either groups. The average hospital stay group 1 was 2.4 days while it was 1.8 days in group 2. CONCLUSION: Both early laparoscopic cholecystectomy (for acute cholecystitis) & late cholecystectomy (for chronic cholecystitis) performed by the experienced surgeon are safe & effective and should be performed as soon as the diagnosis is established preferably within 48-78 hours of the onset of the symptoms.

PAIRED ABDOMINAL FLAP: A RELIABLE HAND SANDWICH FOR DEGLOVING HAND INJURIES
SYED KAMRAN AHMED, SADAF SAEED, MUHAMMAD AMIN CHINOY, MANSOOR ALI KHAN Department of Orthopaedic, Reconstructive and Hand Surgery Jinnah Medical College Hospital & Department of Orthopaedic The Indus Hospital Karachi, Karachi INTRODUCTION: Despite the sophistication in microsurgical techniques, wound coverage for an entirely degloved hand remains a substantial challenge. The paired lower abdominal flap described by Miura and Nakamura provides simultaneous and adequate coverage for the dorsal and volar surfaces of an entirely degloved hand. It has been largely under utilized despite its extreme usefulness. OBJECTIVES: To justify the usefulness of paired abdominal flap in circumferential degloving injuries of the hand. STUDY DESIGN: Case series with review of literature. PLACE AND DURATION OF STUDY: Department of Orthopaedic Reconstructive and Hand Surgery, Jinnah Medical College Hospital and Department of Orthopaedics, The Indus Hospital Karachi, from November 2004 to August 2009. METHODS: Five patients with circumferential degloving hand injuries requiring coverage with a paired lower abdominal flap were included. Three patients underwent paired flap while two refused flap coverage and opted for coverage with full thickness skin graft. The surgical technique is diagrammatically represented. Overall hand function was evaluated through Quick DASH questionnaire. RESULTS: Outcome assessment revealed satisfactory cosmetic and functional recovery with paired abdominal flap. CONCLUSIONS: We recommend this flap for mutilating hand injuries. It can be easily learnt by a well trained orthopaedic or plastic surgeon for salvage of hand in centres with limited microsurgery facilities. KEY WORDS: Hand sandwich; Paired abdominal flap

EARLY LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE vs CHRONIC CHOLECYSTITIS: A PROSPECTIVE COMPARATIVE STUDY
DR SHIREEN RAMZANALI DAMANI1, DR SAGHEER HUSSAIN SHAH2 1Trainee MRCS-3 RCSED & Trainee RMO, 2Associate Professor & Head of Department Surgical Unit III, (Ward 26), Jinnah Postgraduate Medical Centre, Karachi {E-mail: dr_shireenramzanali@yahoo.co.uk} INTRODUCTION: Laparoscopic cholecystectomy has now become a gold standard treatment for patient with chronic cholcystectomy. Laparoscopy has a lower morbidity; cost & hospital stay as compared to the open procedure. Furthermore its believed that the laparoscopic cholecystectomy for the acute cholecystitis is associated with the technical difficulties, higher conversion rate and complications. OBJECTIVE: The aim of this study was to assess the outcome and feasibility of laparoscopic cholecystectomy in patient with acute cholecystitis (early cholecystectomies) as compared to those with chronic cholecystitis (late cholecystectomies). DESIGN & SETTING: This Prospective comparative study was carried out at Ward-26 (surgical unit III ) JPMC from June 2008 to Nov 2009. A total of 125 patients with acute cholecystitis & chronic cholecystitis were treated in this duration. Inclusion Criteria: All the patients with ASA score 1 & 2 were included in the study. Exclusion Criteria:* Patients with symptoms > 72 hrs prior to the admission (n=9) , * Patient presenting with jauindice (n=7) and * Patient with incidential findings of acute cholecystitis on elective laparoscopic cholecystectomies (n=4) and * absolute contraindication to surgery i.e ASA score 3 & 4 (n=3) were excluded from the study. METHODOLOGY: Some 102 fulfilled the criteria & were included in the study, among them 78 were women (76.5%) & 24 were men (23.5%). The age ranges from 19 – 69 years, mean age was 38.4 yrs. These patients were recruited and were divided into 2 groups. Group 1 patients have acute cholecystitis and underwent laparoscopic cholecystectomy (n=19) Group 2 patients are those with chronic cholecystitis & underwent laparoscopic cholecystectomy (n=83) RESULT: The average time for laparoscopic cholecystectomy for acute cholcystitis was 100 min as compared to the chronic cholecystitis which on an average took

OUT COME OF PNL AT JPMC, 05 YEARS EXPERIENCE DR NARESH KUMAR Department of Urology Jinnah Postgraduate Medical Centre, Karachi OBJECTIVES: To determine the efficacy and frequency of postoperative complications of Percutaneous Nephro-Lithotomy (PNL) in clearance of symptomatic renal stones METHODS: A descriptive study conducted in the Department of Urology at jinah postgraduate medical center. The study included 175 patients (105 males, 70 females, aged 15-60 years) Treated with PNL in our department between 2005-2009. The mean (range) Stone diameter was 2.5 (1.5-3.5)cm. RESULTS: Four weeks after treatment the total stone-free rate was 91.2%; 60.8% of all patients were primarily stone-free, 10,4% had clinically insignificant residual stones that passed spontaneously within 4 weeks after PNL, and 29,8% of the patients needed auxiliary measures (a second PNL, ESWL, Ureterorenoscopy). Overall, the early complication rate was 26.4%, the most common complications being transient fever (54.5), clinically Significant bleeding (8, 0%) or both (3.2%); 3.5% of the paritnets developed urinary tract infections (with no signs of urosepsis), 3.2% had Renal colic and 3.2% upper urinary tract obstruction.01 patient needs Nephrectomy due to bleeding, 10 patients required transfusions and there were no injuries to neighboring organs. CONCLUSIONS: These results show that PNL causes no significant blood loss or major complications in almost all patients. Using PNL in an experienced center may especially reduce the potential complications: PNL is a highly efficient procedure that provides fast and safe stone removal. KEYWORDS: Percutaneous Nephro-Lithotomy (PCNL), Renal tract stones, Complications.

SUPERFICIAL BLADDER TUMOR - RECURRENCE AND PROGRESSION
DR MUHAMMAD MANSOOR Department of Urology Jinnah Postgraduate Medical Centre, Karachi OBJECTIVE: To analyze the recurrence as well as progression of superficial bladder tumors. MATERIAL & METHOD: Retrospective analysis of superficial bladder tumor patients presented at JPMC, between January 2005-December 2009. Total 125 patients were selected All patients underwent TURBT followed by active surveillance. Risk factors were analyzed. Recurrence and progression of the disease was noted during surveillance which were dealt in accordingly. RESULTS: Would be presented in scientific symposium session.

RESULTS: Of all the IC, performed at this hospital, complete data was available from 73 patients who were analyzed. Of these 73 patients 65 were male and 8 were female. The mean age was 60 (range 32-88). The mean duration of hospital stay was 14 days (S.D 6.1 days) (8-38 days being the range). Ten patients received pre-operative chemotherapy and radiotherapy, respectively. The mean duration of surgery was 8.4 hrs (S.D 1.5 hrs, range 5-12hrs), with mean estimated blood loss of 1386 ml (SD 670ml). Preoperative radiotherapy was associated with more complications (p=.035). No other factor like ASA, co morbidities, blood loss or duration of stay influenced the complications (p>0.05). Forty three (59%) patients did not have any acute complications. Most common complication were of CG- 2, with 7 pts having wound infection, followed by Uretero-ileal leakage (n 5 each), for which percutaneous intervention under local anaesthesia was needed GC-3a. Mortality rate was 2.7%, classified as CG-V. CONCLUSION: Radical Cystectomy with Ileal Conduit is a major procedure with a good safety profile at this institute. Long term follow up is still needed to look into delayed complications and quality of life.

LAPAROSCOPIC PYELOPLASTY: STENTING TECHNIQUE
DR. KHURRAM SIDDIQUI Section of urology, The Aga Khan University Hospital Reconstructive laparoscopic procedures are challenging for even the most experienced laparoscopic surgeons. Laparoscopic pyeloplasty is considered as gold standard because of the lesser pain, early discharge and quicker return to work. The incision size is minimal and when compared with open pyeloplasty the difference is probably the most appreciated in this procedure. The most daunting task after anastomosis is the insertion of stent. Pre operative stenting collapses the system and make dissection difficult and post operative stenting may be dangerous for the suture line. Intra operative stenting is the most preferred way. How ever it has its own challenges. We present a case of a young male who presented to us with left sided PUJO. We performed left laparoscopic pyeloplasty. The operating time was 420 min and the estimated blood loss for less than 100 cc. the patient was discharged on the second post op day. We present a short video of our technique and share the technical challenges in the procedure.

PREOPERATIVE STANDARD INFORMED CONSENT PRACTICE AT A TEACHING, PRIVATE, TERTIARY CARE HOSPITAL SITUATED IN A RURAL AREA
DR. REHMATULLAH SOOMRO Department of Urology & General/Laparoscopic Surgery Muhammad Medical College Hospital, Mirpurkhas INTRODUCTION: To evaluate the standard preoperative informed consent practice in a tertiary care private sector teaching hospital. DESIGN: Prospective observational study. DURATION: January 2007 to December 2007 PATIENTS AND METHODS: All patients who underwent elective surgical procedures in Surgical Unit, Muhammad Medical College hospital, Mirpurkhas from January 2007 to December 2007 were included in this study. A total of 1032 patients underwent elective surgical procedures during the study period. All of these patients who had undergone elective surgery were interviewed randomly during the study period under routine practice conditions. All the patients were asked a set of standard questions post operatively related to the information they were provided before the procedure as a part of standard informed consent practice. Questionnaire included the patient’s knowledge about pathology, operative risks, type of anesthesia given with its risks, alternate treatment option, results of no treatment, patient’s satisfaction about the information given and whether consent form was signed. RESULTS: A total of 200 randomly chosen patients (121 males and 79 females) were included in the study. In 16 (8%) of patients the surgeons were involved in taking consent themselves. Only 90 (45%) of patients were told about the nature and purpose of procedure and 89 (44.5%) of patients knew about the possible complications of surgery. 143 (71.5%) of patients were told about the type of anesthesia required but only 30 (15%) were informed about the risks of anesthesia. 40 (20%) of patients were allowed questions to be asked while taking consent. Interestingly, most of the patients 156 (78%) were still satisfied by the information provided to them during informed consent. CONCLUSION: This study highlights the poor quality of patient knowledge about surgical procedures and the scarce information provided. The current standard informed consent practice which is being practiced by the doctors in public/private sector teaching hospital of Pakistan and the other world is below standard to international and ethical acceptability. Yet, a large number of patients were satisfied by the information provided during the informed consent process.

URETHRAL STRICTURE DISEASE; A REVIEW OF 100 CASES MANZOOR HUSSAIN, REHMATULLAH SOOMRO, ALTAF HASHMI, ZAFAR HUSSAIN, ANWAR NAQVI, ADIBUL HASAN RIZVI Sindh Institute of Urology and Transplantation Karachi A prospective study on 100 cases of urethral stricture seen at Sindh Institute Of Urology and Transplantation Karachi, revealed majority of them (41) to be in the third to fifth decade of life. They belong mostly (78) to the Urban areas and the commonest site was the bulbar part (43) followed by membranous urethra in 36 cases. Sixty two patients presented with retention of urine, 28 with stream problem, and 10 with recurrent UTI. Road traffic accidents (42) and falls (21) were the most common causes of stricture development. Fifty nine cases were treated with urethral dilatation, 20 by Optical Urethrotomy, and 21 by Urethroplasty. We recommended urethrotomy for simple and short strictures, urethroplasty for complex stricture, and dilatation for superficial, post TURP, and sphincteric strictures or elderly, unfit patients.

GRADING COMPLICATION FOLLOWING RADICAL CYSTECTOMY AND ILEAL CONDUIT FOR BLADDER CANCER USING CLAVIEN GRADING SYSTEM
SYED JOHAR RAZA, M H ATHER, F A KHAN, Z A KHAN Resident Urology Aga Khan University Hospital, Karachi INTRODUCTION: It is now becoming imperative in surgery to report the complications of any surgical procedure using a standard method, and modified Clavien Grading system is one such method. Radical cystectomy and urinary diversion is a major uroncological procedure, associated with various complications. This study determined the 30 day complications of this procedure using a validated system. MATERIALS & METHODS: Patients who had undergone Ileal conduit formation, following Radical Cystectomy for muscle invasive Transitional Cell Carcinoma, were studied, using a prospectively maintained data base. Basic details were determined, and complications noted. These complications were graded according to the Modified Clavien Grading system (CG).

MALIGNANT PHYLLODES: IS RADIOTHERAPY MANDATORY?
DR ALIYA ISHAQ, DR SHADAB KHAN, DR RUFINA SOOMRO. Department of General Surgery, Liaquat National Hospital, Karachi OBJECTIVE: To find out the impact and out come of radiotherapy in the treatment of malignant phyllodes in terms of local and systemic recurrence. METHODS: All patients who came to breast clinic of LNH from 1996 to 2009 and diagnosed as phylloides are reviewed retrospectively .Patient’s age, histopathology, previous history of Fibroadenoma or benign phyllodes, surgical treatment, radiotherapy, and rate of recurrence was reviewed to see the impact of adjutant radiotherapy on rate of local recurrence. RESULTS: Total 260 patients with diagnosis of phyllodes were included in study. 59 were found to have malignant phyllodes.35 patients were recommended to take radiotherapy out of which 7 patients did not take radiotherapy and 28 took radiotherapy. When recurrence rates were compared in both groups it was found

that those who did not take radiotherapy had a recurrence rate of 100% and those who took had a recurrence rate of 32%. CONCLUSION: For malignant phyllodes radiotherapy should be recommended as adjuvant therapy if indicated.

MODIFIED RADICAL MASTECTOMY WITH AXILLARY CLEARANCE USING HARMONIC SCALPEL
DR SHIREEN RAMZANALI DAMANI1, DR SUGHRA PARVEEN2, DR SAGHEER HUSSAIN SHAH3 1Trainee MRCS-3 RCSED & Trainee RMO, 2Assistant Professor, 3Associate Professor & Head of Department Surgical Unit III, (Ward 26), Jinnah Postgraduate Medical Centre, Karachi {E-mail: dr_shireenramzanali@yahoo.co.uk} INTRODUCTION: The surgical treatment of the breast cancer has shifted dramatically from radical operation to the breast conserving surgical technique. The most common complications of the conventional modified radical mastectomy with axillary dissection, electrocautery (diathermy) & the suture ligation are seroma, lymph oedema with the incidence of 11% to 85% and 2% to 50% respectively OBJECTIVE: This study was conducted to evaluate the feasibility, safety & efficacy of modified radical mastectomy with axillary dissection using the harmonic scalpel in terms of operative time, lymph vessel sealing, hemostasis and post operative complications. DESIGN & SETTING (METHODOLOGY): This prospective observational study was conducted in ward – 26 (Surgical unit III) JPMC, from Dec 2008 to Dec 2009. A total of 40 patients underwent Modified Radical Mastectomy and Axillary Clearance during this period. INCLUSION CRITERIA: patients with unilateral , locally advanced breast cancer (T2 AND T3) and ASA (American society of anaesthesia) score 1 and 2 were included in the study. EXCLUSION CRITERIA: patients with early breast cancers (T1) , previous breast surgery, neo-adjuvant therapy , patient with diabeties and other co-morbids were excluded from the study group. RESULT: During one year 40 patients were operated by the same team of surgeon and the lymph vessels sealing and hemostasis were achieved using the harmonic scalpel in all the cases. No clips neither sutures nor diathermy (electrocautery) was used. Among 40 patients, 9 (22%) patients had positive axillary nodes: - 6 patients (15%) had 1-2 positive lymph nodes and 3 patients (7%) had four or more nodes positive. The mean intra-operative blood loss was 45 ml and the mean operative time was 100 minutes. No postoperative bleeding, haematoma, seroma, lymph oedema or other complications occurred. The mean drainage volume was 20 ml and 155 ml respectively and mean drainage duration was 1.3 and 2.7 days respectively. The mean hospital stay was 3.7 days . CONCLUSION: The Modified Radical Mastectomy & axillary dissection using the harmonic scalpel was safe, feasible, and effective. This device simplifies the surgical procedure, reduces the operative time, peri-operative blood loss, drainage volume and duration of drainage. Furthermore the incidence of seroma and lymph oedema was also reduced.

Genetic skin diseases comprise almost 300 rare but often severe/life-threatening diseases and syndromes. Despite recent identification of causative genes in a number of these disorders, the molecular basis of several others are still unknown, and often the function of the identified disease-gene products has been hitherto unsolved. Molecular genetics can provide answers to many unanswered health/disease questions. This relatively young discipline allows research on; i) improved early post-natal and pre-natal diagnosis by novel immunohistochemical/biochemical and molecular tests, ii) identification of new genes involved in genetic skin diseases, iii) definition of genotype-phenotype correlation and characterization of newly identified gene product functions by creation of a sample databank, and iv) stable non viral genetic correction of heritable skin disorders. A brief overview of the avenues of this research and its potential therapeutic applications shall be discussed in this presentation. KEYWORDS: Skin disorders, Skin infections, Molecular genetics, Congenital skin disorders

FREQUENCY OF DIFFERENT SPECIES OF CLINICALLY DIAGNOSED TINEA CAPITIS IN CHILDREN REPORTING IN A TERTIARY CARE HOSPITAL OF KARACHI
DR. MARIA FAROOQI, DR REHANUDDIN, DR. DILAWAR RIZVI & DR. SIKANDAR AZAM MAHAR Institute of Skin Diseases, Karachi INTRODUCTION: Tinea capitis is an infection caused by dermatophyte fungi. There are three recognized patterns: 1. Endothrix: The hair shaft is filled with fungal branches (hyphae) and spores (arthroconidia) termed Black dot. It results from T.tonsurans, T. violaceum and T.soudanense. 2. Ectothrix: The hyphae/spores cover the outside of hair. M.canis, M.Audouinii, M.distortum, M gypseum, and T.verrucosum cause it. 3. Favus: It is a yellowish cup-shaped crust scutula caused by T. schoenleinii.. OBJECTIVE: To determine the frequency of different species of clinically diagnosed Tinea Capitis in children in a tertiary care hospital. STUDY DESIGN: Case series SETTING: Department of Dermatology. DURATION OF STUDY: Six months MATERIAL AND METHOD: Hundred children up to 14 years of age, with tinea capitis confirmed by skin scrapings using 10% potassium hydroxide were included in the study. These were cultured on Sabouraud’s agar at 26-28°C for 4 weeks. RESULTS: Hundred patients completed the study. Siblings of 42% of the patients had dermatophyte infection. The most prevalent species isolated were found to be T.soudanense in 12% of the patients, T.tonsurans in 11%, T.schoenlinii in 4% and T.mentagrophytes 1%. 13% patients had pets at home CONCLUSION: Anthropophilic species such T. soudanense, T. tonsurans, T. shoenlinii and T.mentagrophytes were predominantly affected the population belonging to low/ middle socioeconomic class.

AGE AND SEX DISTRIBUTION AND EFFECT OF VARIOUS FACTORS ON THE COURSE OF ACNE IN PATIENTS ATTENDING OPD AT JPMC
DR AZAM JAH SAMDANI & DR. AHSON GHIAS Department of Dermatology Jinnah Postgraduate Medical Centre, Karachi INTRODUCTION: Acne is a common dermatologic condition that affects many individuals in life. Although classically thought of as a disease of teenagers, it can affect at any age. This study was designed to observe the distribution pattern and various factors affecting the course of disease in our population. MATERIAL & METHODS: This study included a retrospective questionnaire (45 questions), 10 regarding awareness, 15 for dietary factors, 20 for stress. Patients with acne 14-40 yrs either sex and of different ethnic backgrounds were included. RESULTS: This study involved 300 cases. 208 females and 92 males. 267 were single and 33 married. There age distribution was 10-14yrs (44), 15-20 yrs (197), 21-25 yrs (40), 19 were above 30. Lesions were mostly chronic 118 of 1-5 years, 81 above 5 years, 52 (17.3%) 6 – 12 months. Interestingly 71% were not aware that their disease was acne. Diet had significant worsening affect. Oily/spicy affected 100 whereas combination foods affected 84, surprisingly 8 were affected by sweets. Emotional stress was the commonest cause affecting 142 cases, combination of both physical/emotional stress 67 and only 4 patients had physical stress, 44% had premenstrual and 7% had both menstrual/post menstrual worsening.

CONGENITAL SKIN DISORDERS: A BRIEF OVERVIEW OF THE MOLECULAR GENETIC POTENTIAL
ABID AZHAR1 AND AZAM SAMDANI2 1 Dr. A. Q. Khan Institute of Biotechnology & Genetic Engineering (KIBGE), University of Karachi 2 Department of Dermatology, Jinnah Postgraduate Medical Centre (JPMC), Karachi Skin disease has been recently cited as one of the top 15 groups of medical conditions for which prevalence and health care spending has increased manifold recently. In spite of the growing incidences, the data profile on skin disease is scarce and incomplete. The condition is even worst in developing countries like Pakistan. Skin bacterial/viral/fungal infections and hair/nail disorders; are highly prevalent throughout the world. There are more than 3,000 identified varieties of skin disease that can cause symptoms ranging from simple burning and itching, to severe emotional and social effects, to physical disfigurement or even to death where no specific data is yet available.

CONCLUSION: Oily & spicy food, emotional stress and menstrual cycle had a worsening effect on acne and need to be considered in its management.

DERMATOSIS WITH KELOID/SCARS DUE TO DEET (N,N-DIETHYLMETA-TOLUAMIDE)
DR AZAM JAH SAMDANI, DR BAHRAM KHAN & DR QAISERA MASROOR Department of Dermatology Jinnah Postgraduate Medical Centre, Karachi This 70 years old fair skin male presented with lesions starting as pruritic papules on his back/hips/lower limbs/axilla which gradually become larger and ulcerated within short period of time. Some of the lesions have healed with keloid formation. He is a known case of diabetes/hypertension and has history of prostatic hypertrophy. There are no known drug allergies or history of direct exposure to chemicals in relation to his work. On examination, he had multiple well demarcated lesions consisting of eczematous patches, juicy plaques with violaceous hue some of them being ulcerated and some healed lesions with scar/keloid formation. His CBC, LFT’s, urea, cretinine and urine analysis were normal. Serology for ANA, dsDNA, Rh factor, cANCA & pANCA were unremarkable. Histopathology from a lesion on buttock revealed hyperkeratosis/hypergranulosis, lymphocytic perivascular infiltrate, and a few eosinophils in epidermis and near basal layer, suggestive of non specific dermatitis. Immunofluorescence study was negative. Special stains/tissue culture was negative. His clinical picture and histopathology are suggestive of contact dermatosis with keloid/scar formation due to 29% DEET being used by him in the insect repellant (MOSPEL) for the last 01 year daily. There are reports in literature although rare regarding such local effects from use of insect repellants containing this active ingredient in causcacians. It is suggested that such material should be used minimally with extreme care and not for prolonged use to prevent such complications specially in fair skin individuals in our region.

minoxidil (2%) solution in the daytime and isotretinoin (0.05%) gel in the night to avoid photosensitivity. The daily treatment was advised for a period of four months and thereafter every alternate day for another two months as a maintenance therapy. Clinical assessment was carried out by patient’s self-assessment, investigator assessment and clinical evaluation on follow up visits. RESULTS: The total number of patients studied was 54 comprising 31 males (57.4%) and 23 females (42.6%), male to female ratio being 1.3. Twenty-nine patients (53.7%) had three lesions, 18 (33.3%) had two lesions and seven (13%) only one lesion. Complete restoration of hair follicles was noted in 45 (83.3%, p<0.001) by the end of therapy. All the patients with single patch responded (100%), while 15 patients (83.3%) with 2 lesions recovered completely. Twentythree patients (79.3%) with 3 lesions had a complete restoration of hair follicles. CONCLUSION: The combination therapy of minoxidil (2%) solution and isotretinoin (0.05%) gel for alopecia areata is cost effective, stimulating hair regrowth within a shorter interval and is well-tolerated. KEY WORDS: Alopecia areata, minoxidil, isotretinoin, hair follicles.

FREQUENCY AND PATTERN OF NAIL CHANGES IN PATIENTS WITH PSORIASIS VULGARIS
DR JUNAID RABBANI, *DR. IJAZ AHMED, **DR. SARWAT NASREEN *Associate Professor, **Assistant Professor Department of Dermatology Ziauddin University Hospital, KDLB Campus, Karachi AIMS AND OBJECTIVES: To determine frequency and pattern of nail changes in patients with psoriasis vulgaris and to correlate them with severity of the disease. SETTING: Outpatient department of Dermatology, Ziauddin University Hospital, KDLB Campus, Karachi. DESIGN: Cross sectional study. DURATION: Calendar year 2008. MATERIAL AND METHODS: Clinically diagnosed cases of psoriasis vulgaris fulfilling the selection criteria were enrolled after a written consent. All the patients were subjected to a detailed history and clinical examination including systemic and dermatological examination. Nail changes were also observed on examination. Severity of the dermatological disease was graded as mild, moderate and severe. Skin biopsy was performed in addition to other routine or relevant investigations wherever required. All the findings were recorded, compiled and tabulated. Statistical analysis was carried out using the micro software SPSS 13. RESULTS: One hundred two patients fulfilling the selection criteria comprising 55 males (54%) and 47 females (46%), with minimum age of presentation 16 years and maximum 66 completed the study. Age range was 45 years, mean age of presentation being 40.9 years (Standard Deviation: 12.7). Joint involvement in the form of joint pain or restricted movements was observed in 55 patients (54%). Nails were involved in 59 patients (58%) comprising 32 males (54%) and 27 females (46%). Of the 55 patients with joint involvement 39 (71%) had their nails affected. Forty nine (83%) of the patients with nail psoriasis (59) had been suffering from psoriasis for more then 5 years while remaining 10 (17%) for less then 5 years. Among the 59 patients, 27 (46%) had their finger nails involved, 19 (32%) toe nail psoriasis while 13 patients (22%) had both sites involved. Of the 59 patients with nails involved 5 (8.5%) had mild psoriasis, 38 (64.5%) moderate skin disease and remaining 16 (27%) severe psoriasis vulgaris. The most frequent nail finding was roughening seen in 55 patients (93%) followed by transverse ridging and pitting, color change, thickening, dystrophy, subungual hyperkeratosis, onycholysis and leukonychia. CONCLUSION: Nail changes are a frequent feature of psoriasis vulgaris, ridging, pitting and roughening being the most common. Nail dystrophy, color change, onycholysis, leukonychia and subungual hyperkeratosis are the other associated findings. KEY WORDS: Psoriatic arthritis, nail psoriasis, subungual hyperkeratosis, onycholysis, oil drop sign

TWO SISTERS WITH AN INTERESTING PRESENTATION OF LIPOID PROTEINOSIS
DR AZAM J SAMDANI & DR. SOBIA LIAQAT Department of Dermatology Jinnah Postgraduate Medical Centre, Karachi Lipoid Proteinosis is a rare autosomal recessive metabolic disorder of unknown pathogenesis, characterized by deposition of an eosinophilic hyaline like material in extra tissue cellular spaces involving blood vessels; skin, mucous membrane, larynx, trachea, and internal organs. We present two sisters Zara 15 yrs and Sidra aged 9 yrs with skin infections and hoarsness of voice since childhood. Their hoarseness/ low pitch voice was so severe that it is difficult to hear them. On examination they had eczema, with multiple infections and scars involving face, chest and back. Both sisters had characteristic features of Lipoid Proteinosis such as fissured lips, multiple beaded papules along the eyelids, slight macroglossia with a hard woody tongue having a homogeneous look. According to the mother, her husband died at the age of 35yrs with similar skin problem and hoarseness. Their only brother is normal. Routine investigations (Blood CP, SUCE & LFT) along with Abdomen USG and CT scan were normal however buccal mucosa biopsy with P/S stain was highly suggestive of this condition. In short lipoid proteinosis usually presents with a fairly constant, well- defined, clinical, histological and radiological spectrum. This disease is compatible with normal life span, having a stable and slowly progressive course. No curative treatment is available to date. It is important that parents should be counseled about the risks of having affected off- springs.

ASSESS EFFICACY OF COMBINATION OF TOPICAL 2% MINOXIDIL LOTION AND ISOTRETINOIN 0.05% GEL IN TREATMENT OF ALOPECIA AREATA
DR SANA AMIN, IJAZ AHMED*, ZARNAZ WAHID**, SARWAT NASREEN* * Department of Dermatology, Ziauddin Medical University, Karachi. ** Department of Dermatology, Dow Medical College and Civil Hospital, Karachi. BACKGROUND: Alopecia areata is a common cause of nonscarring hair loss. The cause is unknown but it is associated with an alteration in the immunological system. Treatment for alopecia areata includes topical corticosteroids, dithranol, tretinoin, minoxidil, systemic cortisone, PUVA therapy, irritants and immunosuppressive drugs. OBJECTIVE: Our objective was to assess the efficacy of combination of topical 2% minoxidil lotion and isotretinoin (0.05%) gel in the treatment of alopecia areata. PATIENTS AND METHODS: From 1st October 2003 till 30th September 2004, over a period of 1 year, clinically diagnosed, fresh cases of alopecia areata, fulfilling the inclusion criteria were enrolled. All the patients were advised to apply

A CASE OF NON HIV KAPOSI SARCOMA OF SKIN AND GASTRIC MUCOSA
1 DR. SAADIA TABASSUM & 2 DR. ABDUL MANNAN 1 Assist Professor/Consultant, Department of Dermatology 2 Head of Department of Medicine Liaquat National Hospital & Medical College, Karachi Kaposi Sarcoma (KS) is an uncommon condition. We present a case of 62-yearold male, Afghan patient presented to medical outpatient’s unit with multiple subcutaneous nodules. The patient had no known comorbids. The sites of involvement were the face mainly eyelids, forehead, retro-auricular region, left hand, both legs and feet. The patient had lymphedema of both legs. There was generalized ichthyiosis. Oral mucosa was spared. The patient had no visceromegaly at the time of presentation.

A biopsy specimen from the left hand and gastric mucosa revealed Kaposi Sarcoma with dermal lymphatic involvement. His serum was negative for the common types of viral infections including Human Immunodeficiency Virus (HIV) on routine serology. In the north west of Pakistan and Aghanistan, Human Immunedeficiency Virus (HIV) Infections are rare. We mostly come across non-HIV related Kaposi sarcoma.

KEY WORDS: Rural (desert) areas, frequency of scabies disease, Primary health care

REASONS FOR UNSCHEDULED ABSENTEEISM OF REGISTERED NURSES
1 MUSARAT FATIMA & 2 RUKHSANA PARVEEN 1 Assistant Professor, National School of Nursing, LUMHS, Jamshoro 2 Staff Nurse, Bolan Medical College, Quetta PURPOSE: To identify the factors that lead to unscheduled absenteeism in registered nurses. RESEARCH DESIGN: Descriptive exploratory research design METHODOLOGY: SETTING: Study was conducted at one of the leading Federal government hospital at Karachi. POPULATION AND SAMPLE SIZE: Thirty registered nurses including male and females were randomly selected from various units of the hospital. All the selected participants were full time employee of morning shift. DATA COLLECTION TOOL: A survey questionnaire was comprised of 20 close ended questions. ETHICAL CONSIDERATION: A verbal consent was obtained from nursing superintendent and the study participants of above mentioned hospital. DATA ANALYSIS: Descriptive analysis was done in which frequencies and percentages were calculated.

RETICULATED MULTIFOCAL FIXED DRUG ERUPTION DUE TO MEFENAMIC ACID: A NEW MORPHOLOGICAL PATTERN
DR.SADIA MASOOD Consultant Dermatologist Aga Khan University Hospital, Karachi Fixed drug eruption characteristically recurs in the same site each time the drug is administered. It is a heterogeneous pattern of cutaneous reaction to certain drugs. Different morphological patterns of fixed drug eruption can occur and described in various studies. The main presentation of fixed drug eruption was circular, hyperpigmented lesions. Less common presentations included non pigmented erythema, bullous lesions. urticarisa like dermatitis and sometime generalized hypermelanosis. We described a new morphology of fixed drug eruption showing a reticulated pattern as a result of ingestion of Mefenamic acid and discuss the possible mechanism underlying such an appearance. Our case deserves to be mentioned because reticulated pattern is unusual and has not been previously reported. KEY WORDS: Fixed drug eruption, reticulated, mefenamic acid

FAMCICLOVIR EVALUATION PROGRAM
DR ZAFAR ALAM & DR SUNDUS Department of Dermatology Hamdard University Hospital, Karachi STUDY PERIOD: January 2009 –ÊJune 2009 OBJECTIVE: To evaluate the role of Famciclovir in the management of its efficacy & tolerability. Famiciclovir is an antiviral drug which is active against the Herpes viruses, including herpes simplex 1 & 2 (cold sores & genital herpes) and varicellazoster (shingles & chickenpox). Other drugs in the same class include acyclovir (Zovirax) and valacyclovir (Valtrex). Famciclovir is active against the same viruses as acyclovir but has a longer duration of action. Therefore, it can be taken less time each day. Famciclovir relieves pain, burning, itching, tingling, heals and prevents sores associated with herpes infections. Famciclovir was approved for use by FDA in June 1994. 25 patients were on study and follow up with including and excluding criteria. CONCLUSION: famciclover is a good choice of treatment for herpes infections and is so with convenient dosage.

FINDINGS / RESULTS: Participants have different point of view for the reasons of absenteeism against various problems, 86.67% participants responded that conveyance problem; 80 % pregnancy related issues; 73,33% due to child rearing; 80% because of unexpected events at home and 90% due to sickness of family members. MAIN OUTCOME MEASURE: A high rate of absenteeism of employee decreases the productivity in any organization. The increase of absenteeism rate among nurses affects the standard of nursing care services. There may be a number of strategies which can be found to be successful in reducing absenteeism of registered nurses. CONCLUSION: It has been identified that the selective factors reflect the higher rate of absenteeism in nursing profession that impacts on health care. By identifying these factors the absenteeism rate could be reduced. KEY WORDS: Absenteeism. Nurses

IMPORTANCE OF CONTINUING NURSING EDUCATION
HUSAN BANO CHANNAR MScN Part-II Student College of Nursing Jinnah Postgraduate Medical Centre, Karachi The nursing profession believes that learning needs to be a continuous process throughout the lifespan. Learning is individual and diversified for each person. Individual nurses are responsible for their own learning and should participate in the identification of their own learning needs to meet these identified needs. Providers of Continuing Nursing Education must have a commitment to involve learners in the learning process from the initial stages of planning through the evaluation of organized learning experiences. Continuing Nursing Education should be provided in a well-planned, organized educational environment. Continuing Nursing Education should serve as a viable means of improving the professional competence of the practitioner with the outcome of improved health care. The purpose of this study was to explore the importance of continuous nursing education for enhancement of nursing profession and to assess the awareness of continuous nursing education, in tem to raising the quality of individual as nurse. The importance of Continuing Education for nurses has been increasingly emphasized in the nursing literature since the beginning of the profession. Learning opportunities are provided through classroom attendance, one-to-one mentoring, self-study experiences and the application of other adult education concepts. The National Nursing leadership, Nursing Administrators and Nursing Educators are in agreement that there is a potential knowledge gap between nursing education and nursing practice (Joyce-Nagata, Reeb, & Burch, 1989). Descriptive study design student was used and nurses of post RN BScN, class of 2006 were included in sample population. Data was collected through a survey questionnaire consisted of questions related to demographic profile of the participants. Participants’ written consent was obtained to maintain the ethical value of the study. Majority of the participants were female and it is a known fact the nursing by profession is considered as female profession. Majority of the participants responded that they agree that continues education is important.

FREQUENCY OF SCABIES IN RURAL (DESERT) AREAS IS STILL THE PRIMARY HEALTH CARE CHALLENGE
DR: JEWAT SUNDER, DR: SATTI JEWAT FIAZ AHMED JATOI, HAZOOR BUX LAGHARI Peoples Primary Health Care Initiatives, Sindh {E-mail: dr_jewat@yahoo.com} AIM & OBJECT: Our aim to promote health activities, health education (Awareness) in the community and schools, and the object is to strength the basic health facilities, with provision of free of cost medicine availability. METHODOLOGY: Descriptive study of 3 month analysis on SPSS version 11. RESULTS: There are many health problems (infectious diseases) for working at grass root level regarding health especially primary health care, the skin disease (scabies) is one of them. Analysis of three month data the results were: Out of the total three month OPD (152754) the scabies were (20895) 13.67% Under one year (12668) the scabies were (1311) 10.34% Under one –four year (13383) the scabies were (4076) 30.45% Under 5-over years (106703) the scabies were (15508) 14.53% CONCLUSION: Though the health problems (infectious diseases) are more challenging problem especially in rural (desert) areas scabies is also one of them, for the scabies. The role of benzoyl benzoit along with chlorpheramine was seen beneficial in above given data.

After study group are able to conclude that the nurses have strongly agreed that continuous education is a fundamental, long life process and knowledge obtained through this process facilitates to provide quality care to their patients.

PERCEPTIONS OF NURSES ABOUT THE DIPLOMA IN TEACHING AND ADMINISTRATION NURSING PROGRAMME KARACHI, PAKISTAN
DURR-E-SHAHWAR PASHA Nursing Instructor College of Nursing Jinnah Postgraduate Medical Centre, Karachi {Email durreshahwarpasha@yahoo.com} INTRODUCTION: Educated and well qualified nurses are the backbone of a health system. Well-qualified nurses with higher education are a valuable resource, as they are competent professionals and are essential in providing a high standard of care to the public. Literature highlights the need and importance of competent teachers for improving nursing education and service in the country. In Pakistan, the nursing teachers working in the schools of nursing in the government sector are graduates of the Diploma in Ward Administration (DWA) and Teaching and Administration (DTA) programs. The previous evaluation studies on the general nursing programme indicated dissatisfaction with the competencies of the nursing teachers, who were DTA graduates. One of the reasons attributed to lack of competence in teachers was ineffectiveness of the DTA programme. METHODOLOGY: This study explored the nurses’ perception about the DTA programme offered in a college of nursing in the province of Sindh. An exploratory descriptive qualitative approach was adopted to answer research questions. Using a semi-structured interview guide, nine study participants were interviewed. The data analysis process involved several steps, and analysis was done manually. Data was coded to form nine categories, which were further merged to form four themes of course content, course implementation, utilization of knowledge, skills and attitudes gained, and participants’ recommendations. RESULT: Findings of the study indicated that participants generally perceived their DTA programme as ineffective, and provided recommendations for revision of the DTA curriculum to include courses at an advanced level, provision of modern learning resources and enhancement of the academic environment. They also provided suggestions for policy makers regarding utilization of the graduates of the DTA programme in the country. CONCLUSION: The recommendations for further research include obtaining data from several stakeholders such as students, graduates, faculty, patients (clients) and employers in Pakistan, to explore the DTA programme in depth. The findings, recommendations and conclusion of the study will, therefore, be beneficial for the preparation of future nurse.

IMPLICATIONS OF FACULTY MEMBERS BECOMING STUDENTS IN THE SAME INSTITUTION
DR. RAISA B. GUL, MS. SALIMA MOEZ, MS. RUBINA BAROLIA Aga Khan University School of Nursing, Karachi BACKGROUND: Approximately 30 % of the Master’s of Science in Nursing (MScN) students at ABC School have been the faculty members before their enrollment into the program. Transition of roles may lead to feeling of dislocation, threat to identity or lost academic confidence. Nursing literature is replete with research about the transition of nursing students to staff role. Limited work is found about the transition of nurses from a staff nurse to a student role, but no studies are found about the transition from a teacher to student role. PURPOSE: The purpose of this study was to identify and describe the experiences of students in the MScN program who undergo through a role transition from a faculty to a student status in the same institution and how such experiences affect their learning. METHODS: In line with qualitative approach, purposive sampling method was used to enroll 10 informants, MScN students and faculty members, in this study. Following the inclusion and exclusion criteria, data was collected through semistructured interviews. With the individuals’ written consent, interviews were taperecorded and transcribed verbatim. Data was analyzed manually for themes and categories. Findings indicate multiple advantages and disadvantages for faculty members becoming graduates students at their own institution. Familiarity with institutional culture, people, and policies seems to ease the burden of adjustment in their new role but also limit their freedom as students. They perceive to live in a dual identity of student and faculty which has consequences for themselves, their peers, and those who teach them. CONCLUSION: Appropriate structures and thoughtful processes should be in place to curtail the negative effects of faculty going for higher education in the same institution.

PRACTICES OF PATIENTS’ TEACHING FOR DISCHARGE AFTER A DAY SURGERY
DR. RAISA B. GUL* AND MS. NUZHAT SULTANA** *Aga Khan University School of Nursing, Karachi ** Shifa International Hospital, Islamabad BACKGROUND: The concept of day surgery has been introduced to bring efficiency; however, the success of day surgery is strongly associated with patients’ preparedness for self-care at home. This paper presents findings of a study that aimed to explore the process and content of patients’ discharge teaching for self-care at home after receiving their discharge teaching on a surgical day care unit (SDCU). METHODS: Following an exploratory descriptive approach, 60 patients, who had undergone a day surgery at a private tertiary care institution, comprised the study. Using a structured checklist and a questionnaire, data was collected through participant observations and patients’ interviews respectively. Both descriptive statistics and manual analysis were performed to interpret the data. RESULTS: The findings revealed that none of the patients received complete information on all the required aspects of teaching to prepare them for self-care at home. Doctors and nurses both were involved in discharge teaching, but it was fragmented and uncoordinated. In most of the cases, verbal information was provided to the patients and or their family members at the unit reception counter. Although 58% of the patients expressed satisfaction with the instructions for self care at home, 95 % of all patients had questions/concerns about various aspect of care including their pain management; take home medications, and wound care. CONCLUSION: The findings indicate that patients discharge teaching for selfcare after a day surgery has much room for improvement. Therefore, it calls for an urgent attention of hospital management to improve the discharge teaching process in the SDCU.

WOMAN’S PERCEPTIONS OF NURSING SUPPORT DURING CHILD BIRTH
MS. NASREEN GHANI, MS.SHAHEEN GHANI Post Graduate College of Nursing Peshawar BACKGROUND: is a sentinel event and positive experience of woman’s life. How the woman responds psychologically to this event to some extent depends on the types of support she receives. The quality of support provided, influences the woman’s satisfaction with the birth process PURPOSE: The purpose of the study was to investigate women’s perception of care and support during childbirth and how these experiences related to nursing support affect their child birth process. METHODS: In line with descriptive approach purposive sampling method was used to enrolled 30 participants, primi and multi gravid. In this study, following the inclusion and exclusion criteria, data was collected through semi-structured interviews with individuals’ verbal consent, interviews were tape-recorded and transcribed verbatim. Data was analyzed manually for themes and categories. FINDINGS: indicate that Both primi and multi para have different expectations during labor most of the women’s were praising there nurses who support them during their child birth process ,while the major concern was found about insufficient nursing care and changing of nurses during labor CONCLUSION: No matter what the birth country or setting, the supportive professional care giver at childbirth will help women to face with the stresses and pain. Further qualitative studies with large samples are needed to improve our perceptive of the individually supportive role of the professional care giver during child birth.

DEVELOPMENT OF NURSING EDUCATION IN PAKISTAN
FOUZIA NAZ College of Nursing Jinnah Postgraduate Medical Centre, Karachi The modern nursing profession in the world is relentless effectors of Florence Nightingale's, who marked the beginning of modern nursing era for helping the suffering humanity without distinction. Like other professions . There are mainly five fields of study launching within the Nursing Graduate Program. Such as Health of Population, Wellness and Healing Across the Lifespan, Health Services and Policy, Nursing Leadership and Practice and Nursing Education. Today there are about 57,646(2007) nurses in Pakistan as compared to 350 nurses at the time of independence in 1947. Today We have 162 school of Nursing, 98 school of Midwifery, C.M.W 79 .P.M 10 .L.H.V 30 and 02(F.GOV) college of Nursing in Pakistan, total nursing school in panjab72,sindh59,.N.W.F.P19,Blochistan12, from where nursing gradates are qualified and providing nursing services to the masses of Pakistan. We know that nurses are the backbone of the medical profession which includes the doctors, nurses and paramedical staff. But unfortunately the nursing institutions are very much discriminated for many domains from the medical colleges. This discrimination is result in many issues and problems which the nursing students and nursing institution faulty faces in educating the nurses, this include the nurses dependence on hospitals administration, No separate budget, Shortage of Faculty, No establishment staff, No role in educational planning and Management, Students are utilized for services, limited library services and Limited teaching learning resources. The nurses are also confronting many Issues/problems which are hindrance in the delivery of nursing services to the clients, these include, Inadequate infrastructure, teaching and learning facilities, limited availability of teaching/learning material and text books, shortage of nursing teachers and subject specialist teachers, Inadequate standards of education, Language barrier, Shortage of clinical instructor, Inadequate institutional policy,teacher students ratio 1:23(PNC).teacher student 2:25 for diploma program ,1:1for post basic level(subject) Students are used as workers,. The nursing education is also facing many problems in admission in higher nursing education such as, B.Sc.N, M.Sc.N and Ph. D Nursing, as there are few higher nursing education institutions in private and public sector to accommodate the nursing professional to enhance their profession.. Nursing faculty positions have upgraded to BS-20. B.S.C Nursing programs have been initiated in public sector. Increase in sanctioned number of budget position of student nurses. Up-gradation of chargeÊnursesÊBS14-16, HeadÊNurses BS-16-17. Establishment of nursing cells in all health sciences universities. Scholarships for faculty development of degree and diploma program.

graduates of the DTA programme in the country. CONCLUSION: The recommendations for further research include obtaining data from several stakeholders such as students, graduates, faculty, patients (clients) and employers in Pakistan, to explore the DTA programme in depth. The findings, recommendations and conclusion of the study will, therefore, be beneficial for the preparation of future nurse.

SWINE FLU: INFORMATION IS THE BEST PREVENTION (The daily “DAWN” Thursday, December 31, 2009)
HIDAYATULLAH College of Nursing Jinnah Postgraduate Medical Centre, Karachi Swine flu is a disease of respiratory system caused by a new influenza virus (H1 N1) spreading from person to person. in 1918 when human and pigs became sick at the same time (disease related human influenza).in 1930 H1N1 was discovered in pigs.1976 United state outbreak: united state army was died and cause declared H1N1. In 1988 Zoonosis killed women and infect one eight month pregnant women after visiting Hog.1998 outbreak in the united state.2009 pandemic outbreak in Humans: ANALYSIS: Swine flu contain genetic material from Swine + avian + Human. Mostly young adult older children, pregnant women and morbid obesity are at high risk. General measure for prevention and protection cleanliness and avoiding contaminated source Howe ever treatment is drugs are available in the form of Tamiflu, Relenza (syrup, tablets and inhaler). For prior protection WHO provide vaccine on priority basses. RESULT: 208 countries were affected. WHO Director declared a “public Health emergency of international concern”.) In 2009 out break10, 000 deaths occurs world wide. In Pakistan first case was detected on 10th august 2009 and till now it is 52. Government trying to overcome problem through public awareness, health education, constructing of isolation wards in hospitals, insuring of availability of drugs and health personnel at different health centers and hospitals. The government also develops an information system to speedy overcome this hazardous problem.

PERCEPTIONS OF NURSES ABOUT THE DIPLOMA IN TEACHING AND ADMINISTRATION NURSING PROGRAMME KARACHI, PAKISTAN
DURR-E-SHAHWAR PASHA Nursing Instructor College of Nursing Jinnah Postgraduate Medical Centre, Karachi {Email durreshahwarpasha@yahoo.com} INTRODUCTION: Educated and well qualified nurses are the backbone of a health system. Well-qualified nurses with higher education are a valuable resource, as they are competent professionals and are essential in providing a high standard of care to the public. Literature highlights the need and importance of competent teachers for improving nursing education and service in the country. In Pakistan, the nursing teachers working in the schools of nursing in the government sector are graduates of the Diploma in Ward Administration (DWA) and Teaching and Administration (DTA) programs. The previous evaluation studies on the general nursing programme indicated dissatisfaction with the competencies of the nursing teachers, who were DTA graduates. One of the reasons attributed to lack of competence in teachers was ineffectiveness of the DTA programme. METHODOLOGY: This study explored the nurses’ perception about the DTA programme offered in a college of nursing in the province of Sindh. An exploratory descriptive qualitative approach was adopted to answer research questions. Using a semi-structured interview guide, nine study participants were interviewed. The data analysis process involved several steps, and analysis was done manually. Data was coded to form nine categories, which were further merged to form four themes of course content, course implementation, utilization of knowledge, skills and attitudes gained, and participants’ recommendations. RESULT: Findings of the study indicated that participants generally perceived their DTA programme as ineffective, and provided recommendations for revision of the DTA curriculum to include courses at an advanced level, provision of modern learning resources and enhancement of the academic environment. They also provided suggestions for policy makers regarding utilization of the

SEVERITY OF MENOPAUSAL SYMPTOMS AND THE QUALITY OF LIFE AT DIFFERENT STATUS OF MENOPAUSE: A COMMUNITY BASED SURVEY FROM RURAL SINDH.
1 NUSRAT NISAR, 2 NISAR AHMED SOHOO 1 Department of Obstetrics & Gynecology, Liaquat University of Medical and Health Sciences Jamshoro 2 District Coordinator National Programm for Family planning & Primary Health Care, Matiary Sindh Pakistan. {Email: nushopk2001@hotmail.com} INTRODUCTION: Menopause is the time in women’s life when her ovaries stops producing Estrogen and Progesterone, the deficiency of these hormones elicit various somatic, psychological, vasomotor and sexual symptoms that affect the overall quality of life of women. Assessment of quality of life during menopause deserves special attention as with increase in the life expectancy women lives about one third of their lives with hormone deficient state. Studies on menopause and quality of life of menopausal women are scarce and none is conducted before among rural women of Sindh Province Pakistan. OBJECTIVE: To investigate the severity of menopausal symptoms associated with menopausal status and to determine the quality of life of menopausal women from rural Sindh. MATERIAL AND METHODS: This cross-sectional survey was conducted in 19 Union Councils of Matiary district, Hyderabad Division from November 2007 to October 2008. Among 6, 29382 population dwelling in 1509 villages and 56,053 households of these Union Councils, 3062 women were selected by multistage random sampling method within the age range of 40-70 years. Along with collection of socio-demographic data the Menopause rating Scale (MRS) and WHO Quality of life Brief (WHO QOL Brief) Questionnaire translated in Sindhi Language were filled for each individual subject. Data was entered and analyzed by SPSS V 15. RESULTS: The mean age at Menopause was 49.38±14.29 years; the mean scores of menopause rating Scale were high in all domains, the significant difference was found in the mean somatic scores of women in Premenopause, perimenopause and post menopause status (P=<0.001). The psychological

symptoms were more severe for women in perimenopause and post menopause status while the scores for urogenital symptoms were found to be higher in perimenopause women (P=<0.001). The mean scores for the physical, psychological, social and environmental domains of WHO QOL questionnaire were found significantly impaired for all women at different status of menopause. CONCLUSION: To best of our knowledge this is the first attempt to provide data on menopause and quality of life of women from rural Sindh. The mean scores of all the domains of Menopause rating scale were significantly high in Peri and postmenopausal women from rural Sindh. The severity of menopausal symptoms decreases the quality of life in every day life of these rural women. KEY WORDS: Menopause, Severity of symptoms, MRS, Quality of life, WHOQOL

because of threatened blood loss. A mean of 4 units of blood and FFP were transfused. Post operative morbidity during the period between C-section and hysterectomy included Postpartum Haemorrhage =2, Pelvic infection =2, coagulation defect =1. Mean hospital stay after hysterectomy was 8 days (712).There was no thirty days mortality in this series. CONCLUSION: Interval hysterectomy helps in controlling both morbidity and mortality in patients with life threatening placenta percreta.

KNOWLEDGE AND ATTITUDE OF MEDICAL STUDENTS OF DUHS ABOUT CONTRACEPTION
DR HALEEMA YASMIN, TOOBA MALIK, USAMA AHMED Department of Gynaecology & Obstetrics (Ward-8) Jinnah Postgraduate Medical Centre, Karachi OBJECT: To study the knowledge and attitude on various contraceptive methods among medical students of DUHS. STUDY DESIGN: questionnaire based study SETTING: Sindh Medical College and Dow Medical College Subjects: students of third, fourth and final year. METHOD: A pre-structured proforma was given to the consenting students to fill and return at the same time. RESULTS: Out of the total responders majority were females almost 85%,they knew very less about modern methods as well as emergency contraception, majority felt that conventional and folk methods are effective ,knowledge about side effects was judgmental mostly ,almost all of them felt that their knowledge is not upto the mark ,30% felt that it is socially stigmatized factor to be discussed. CONCLUSION: The first step towards achieving success in our family planning programme lies in imparting correct knowledge and more information to this target group by incorporating more lectures during medical education and arranging interactive sessions. KEY WORDS: Medical students, knowledge, attitude, contraception.

RELATIONSHIP OF GESTATIONAL DIABETES MELLITUS WITH POLYCYSTIC OVARIAN SYNDROME
SHAHZAIB PERVEZ 1, SADAF MANSOOR 2, YUSRA MIDHAT 2, SUMYYA GHAZAL 2, MAHAK IRFAN 2, SUMERA SOHAIL 2, WASEEM SIDDIQUI 3, FARAH ASAD MANSURI 3 1,2 Medical Students 3 Department of Community health Sciences Karachi Medical & Dental College, Karachi INTRODUCTION: Gestational diabetes is defined as glucose intolerance that is first detected during pregnancy. The detection of GDM is important because of its associated maternal and fetal complications. Gestational diabetes is estimated to complicate 3-10% of all pregnancies OBJECTIVE: To study whether Gestational Diabetes Mellitus is related with Polycystic Ovarian Syndrome. MATERIAL AND METHODS: It was a case control study conducted on pregnant ladies with gestational diabetes mellitus (GDM) and their controls attending antenatal clinics of Abbasi Shaheed and Lady Dufferin Hospital. A purposive sample of 140 was selected from the two hospitals; out of which 35 were cases of GDM and 105 were controls. RESULTS: Out of 140 subjects 14% of cases and 11% of controls were in age of 30.It was found that 17% of cases and 9% of controls had weight between 74-76.About 51% of cases and 56% of controls belonged to lower middle class. Out of 35 cases, 22% (08) were with PCOs and 46% of them had family history of diabetes. It was seen that 49% of them were obese as well. CONCLUSION: This study proved that women with Gestational diabetes mellitus were 5.9 times more likely to have clinically diagnosed polycystic ovarian syndrome as compared to their controls. Age and weight were found to be the significant covariates. KEY WORDS: Gestational diabetes mellitus, polycystic ovarian syndrome, polycystic ovaries, GDM

KNOWLEDGE REGARDING RH DISEASE AMONG FEMALES WITH 1ST PREGNANCY IN A COMMUNITY
*SADIA NASIM, MUHAMMAD AYAZ MUSTUFA, AND ANJUM SHAHID *Research Officer, Pakistan Medical Research Centre, NICH, Karachi {E-mail: sadianasim@yahoo.com} BACKGROUND: Despite the introduction of Rhesus (Rh) immunoglobulin in 1968, hemolytic disease of the newborn (HDN) remains a serious concern. It was reported that an overall incidence of HDN is 10.6 cases per 10,000 deliveries, with a wide geographic variation. HDN was a significant cause of fetal mortality and morbidity until the introduction of amniocentesis, intrauterine transfusion, and exchange transfusion in the management of severely alloimmunised women and their fetuses. As per procedures are very expensive and non-accessible in our country so to prevent HDN, sufficient knowledge regarding blood group prior to delivery will be helpful and there is evidence for the efficacy and effectiveness of blood typing and anti-D antibody screening during pregnancy. OBJECTIVES: The purpose of this study is to assess knowledge among females with 1st pregnancy regarding Rh disease and their risk to mother and child and to create awareness regarding importance of blood group during pregnancy. SETTINGS: A questionnaire survey was conducted in Sector 33B, C, D, E, and F of UC-7 of Korangi town representing low socioeconomic group. Systemic sample plan was applied. METHODS: 350 married females with 1st pregnancy were included in a study after having a formal informed consent. A structured questionnaire was utilized to assess the knowledge regarding Rh disease and HDN which include questions comprising of maternal and child health, complications during pregnancy, whom they consulted during pregnancy, have they ever visited health care centre during pregnancy and some questions regarding importance of blood group. Rh grouping was also done by rapid slide technique. For Rh Positive blood group cards were issued at the spot while negative blood group was confirmed at laboratory via reverse blood grouping and card was issued next day. RESULTS: In our selected population 81.4% females had no knowledge about their blood group. And only 4% knew their husband blood group. About 51% females were married to blood relatives and only 2% knew about complication (during pregnancy) related to negative blood group. Frequency of visiting health care centre during pregnancy was by 43.7% while 8% never visited health care centre. Blood group was determined in 350 females, the percentages of these among Rh Positive were A (21.1%), B (31.7%), AB (9.7%), O (29.1%), and among

ROLE OF INTERVAL HYSTERECTOMY AND METHOTREXATE IN PREVENTING MORTLAITY IN PLACENTA PERCRETA
SABA KHAN, SAMIA SHUJA, KHADIJA BANO, NAGINA FATIMA Department of Obstetrics and Gynaecology Jinnah Postgraduate Medical Centre, Karachi. INTRODUCTION: Placenta percreta is a rare but life threatening obstetric complication with a mortality in access of 6.5 % in most centers at the time of delivery. Hysterectomy at the time of C-section is often complicated by severe, uncontrolled hemorrhage resulting in life threatening morbidity and mortality. Interval hysterectomy is often necessary to avoid this high rate of morbidity and mortality. A study was conducted to determine the role of interval hysterectomy in our centre. PURPOSE: To determine the value of planned interval hysterectomy in preventing mortality in placenta percreta cases. MATERIALS & METHODS:- This case series includes well patients with placenta percreta managed over a period of two years from January 2008 To December 2009 at the Department of Obstetric and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi. RESULTS: There were 12 patients seen in the specified period. All were seen beyond 33 weeks of pregnancy. All patients received 50mg methotrexate I/M. The mean age was 30 years(25-35 Years) and parity was less than 4. There was history of placenta previa in 4 patients (33.3%) C-section in all 12 patients (100%), history of manual evacuation/curettage in 3 patients (25%) and hematuria in 4 patients (33.3%). All patient under went planned interval hysterectomy in an average of 3 weeks after the classical caesarean section. Bladder wall was involved in 4 patients (33.3%) and it was primarily repaired in all four. Bilateral Internal Iliac arteries were ligated in 5 patients (41.6%) during Classical C-section

Rh Negative were A (2.0%), B (2.9%), AB (1.1%), and O (2.3%). Overall 8.3% females were found to be Rh Negative and B blood group is commonest among both Rh Negative and Rh Positive. CONCLUSION: Awareness regarding blood grouping was very poor in females of the study population.

PATTERN OF CERVICAL CANCER CANCERS IN KIRAN, KARACHI
HINA HASHMI, SYED AMIR MAQBOOL, ADEEL AHMED, KULSOOM BEGUM & TAHSEEN FATIMA Karachi Institute of Radiotherapy and Nuclear Medicine Karachi OBJECTIVE: Cancer of the Cervix is the second most common cancer in females worldwide. According to the institution based data of KIRAN, it ranks 3rd most common cancer in females accounting for 5.5% of all female cancers and 42.6% of all gynecological malignancies. The aim of the study is to summarize the data of the patient suffering from cervical cancer and evaluate the risk factors, stage and mode of presentation at our institute. METHOD: In this retrospective study, case files of patients of last 6 months with invasive cancer of cervix were studied with respect to personal profile, disease related risk factors, stage and mode of presentation RESULTS: 43 patients of cervical cancers ranging in the age group of 35-80 years (mean age 50.93) were registered in the cancer OPD. Of these, maximum no of the patients were in stage II-B (26%). In rest of the stages were I-A (2%), I-B (7%), II-A (23%), III-A (7%), IIIB (7%), IV-A (19%) and 9% had metastatic disease to liver, lungs or bones. Early age at marriage (mean age16.8yrs), multiparity and multiple marriages of the spouse were the major risk factors identified in our patients. Most patients belonged to low socio-economic status, with anemia and poor nutritional status. Per vaginal bleeding was the universal presenting complaint among all patients. Other major symptoms include pervaginal discharge, post-coital bleeding, lower abdominal pain and urinary symptoms. One patient also presented with recto-vaginal fistula Most of the patients had incomplete treatment and were lost to follow-up because of lack of awareness and ignorance. CONCLUSION: Cancers of the cervix mostly present in advanced stage which necessitates the implementation of screening programs at national level

FIRST TRIMESTER THREATENED MISCARRIAGES AND RELATED OBSTETRICAL COMPLICATIONS
S AHMED, RN QURESHI Department of Obstetrics and Gynecology Aga Khan University, Karachi INTRODUCTION: Threatened miscarriage defined as vaginal bleeding before 24 weeks of gestation is a complication affecting 15%-20% of viable pregnancies. We hypothesized that it is associated with increased risk of obstetrical complications OBJECTIVE: To assess the effect of first trimester threatened miscarriage on pregnancy outcomes. MATERIAL AND METHODS: A Prospective Cohort study was conducted from March 2007-April 2008.A total of 1,365 women with singleton viable pregnancies confirmed on ultrasound were recruited for the study. 273, pregnant ladies with threatened miscarriage were considered in the Exposed group and 1,092 women who had no threatened miscarriage were considered in Un- Exposed group. RESULTS: Threatened miscarriage was found to be significantly associated with complications like PPROM (RR=3.64, p <0.001), Abruptio placenta (RR=3.46, p<0.001), Placenta previa (RR=2.57, p=0.001), Gestational hypertension (RR=1.96, p<0.001), Preterm birth (RR=3.79, p<0.001), Intrauterine Growth Retardation (RR=3.02, p<0.001) and Pregnancy loss (RR=4.31, p <0.001). It also increases the risk of Cesarean sections (RR=1.43, p=0.025) and NICU admissions (RR=3.45, p<0.001). CONCLUSION: Patients with threatened miscarriage are at increased risk of adverse pregnancy outcomes like PPROM, preterm birth, IUGR, gestational hypertension and placental complications (abruptio placenta and placenta previa).The risk of cesarean delivery, NICU admission and spontaneous pregnancy loss is also increased in this group. KEY WORDS: Threatened miscarriage, Preterm birth, Placental abruption, Preterm premature rupture of membranes

VAGINAL HAEMOLYTIC ENTEROCOCCI AMONG WOMEN FROM BALOCHISTAN: POSSIBLE INDICATOR OF BACTERIAL VAGINOSIS
ARIFA JABEEN KAKAR1, NUSRAT JABEEN2,4, MUSHTAQ HUSSAIN2,4, SYEDA QAMARUNNISA3, ZAFAR AHMED1, SHAKEEL BABAR1 & SHEIKH AJAZ RASOOL4 1Department of Microbiology, CASVAB, University of Balochistan, Quetta, 2Department of Molecular Pathology, Dow University of Health Sciences, 3Institute of Biotechnology and Genetic Engineering (KIBGE), 4Department of Microbiology, University of Karachi-75270, Karachi BACKGROUND: Bacterial vaginosis is characterized by whitish grey discharge rendered by overgrowth of various bacterial species in the vagina and leads to the disturbance of normal microbial flora of the system. Among half of the cases of bacterial vaginosis, the disorder is asymptomatic and only detected by vaginal swab. One prevalent form of bacteria found in this connection is haemolytic enterococci. OBJECTIVE: The present study is focused to explore the prevalence of haemolytic enterococci in vaginal samples among the women inhabiting in the Balochistan province. MATERIALS AND METHODS: 450 patients attending Gynecology OPD of tertiary care hospitals, BMCH Quetta and Sandeman Provincial Hospital Quetta during May 2009 to August 2009 were requested for an Informed consent. However, only 55 women agreed to volunteer in the study. From each subject two vaginal swabs and one Pap smear were taken. One swab was subjected to direct smear microscopic examination, gram staining and Whiff’s test while other swab was placed in the transport medium. The later were streaked on 5% human blood agar plates and haemolytic patterns were observed after 24-48 hours of incubation. RESULTS AND DISCUSSION: In total 160 aerobic bacteria were isolated from different culture media. Of these 55 (34%) were identified as cocci, out of these cocci 34( 62%)were gram+ve and 21 (38%) were gram-ve. The less percentage of gram negative cocci may be inferred in terms of using blood agar rather than the chocholate agar, a preffered medium for Neisseria isolation. Another possible explanation could be the bacteriocinogenic potential of gram positive cocci. All gram positive cocci were subsequently streaked on Bile Esculin agar plates and incubated aerobically to check their esculin hydrolytic ability. Haemolysis of blood in enterococci is only mediated by a bacteriocin or lantibiotic, cytolysin, which to date has only been detected among enterococus faecalis strains. Thus, esculin hydrolysis (resulting in black colour pin pointed colonies) and hemolytic pattern conjointly delineate the isolates as E. faecalis. â- hemolysis was produced by 54% of isolates while 27% have exhibited á-hemolysis. The high prevelance of hemolytic enterococci in these vaginal samples and their association with sign and symptoms of bacterial vaginosis implicates the potential of enterococci to be used as an indicator for bacterial vaginosis. Further studies in this connection are underway. KEY WORDS: Enterococcus, Vaginal flora, Bacteriocin, Hemolytic enterococci fecalis

FREQUENCY OF CERVICAL AND ENDOMETRIAL CARCINOMA IN LOCAL POPULATION AT HYDERABAD DISTRICT
FARKHUNDA NADEEM* SAJIDA AGHA** S. HAIDER RAZA*** *Assistant Professor, Department of Pathology. **Associate Professor, Department of Medical Education. ***Assistant Professor, Department of Pharmacology Isra University Hyderabad {E mail: drfarkhunda@hotmail.com} OBJECTIVE: This study was conducted to know the frequency of cervical and endometrial carcinoma in local population of Hyderabad district presented to Isra university hospital Hyderabad, Pakistan. METHODOLOGY: 500 hysterectomy specimens were received in the Histopathology department of Isra University Hyderabad during the period of January 2004 to December 2008. Out of these, 50 cases showed the presence of cervical or endometrial carcinoma on histo-pathological analysis. Specimens were preserved in 10% formalin and thorough naked eye examination was done. Representative blocks were taken and processed for paraffin embedding. RESULTS: A total of 500 hysterectomy specimens were received in the department of Histopathology at Isra University Hyderabad. Out of these cases 50 specimens showed the presence of either endometrial carcinoma or cervical carcinoma. The mean age of these 50 hysterectomised patients was 51.62±10.64. The data analysis showed that 60 percent cases belong to endometrial carcinoma while 40 percent cases showed the presence of cervical carcinoma with a p-value < 0.05. CONCLUSION: This study was done in order to compare the frequency of cervical versus endometrial carcinoma and it was concluded that endometrial carcinoma is as common as cervical carcinoma in Hyderabad. This is in contrast with the results of many studies conducted in USA which shows that endometrial carcinoma is more prevalent in developed countries while cervical carcinoma is common in developing countries. The factors leading to the increased frequency of endometrial carcinoma in Hyderabad are yet to be discovered. KEY WORDS: Endometrial carcinoma, Cervical Carcinoma, Hysterectomy

OUTCOME OF OCCIPITAL ENCEPHALOCELE
DR. ABDUL BASIT, A. M. MAMOON, DR. LAL REHMAN AND PROF. A. SATTAR M. HASHIM Department of Neurosurgery Jinnah Postgraduate Medical Centre, Karachi INTRODUCTION: Occipital encephalocele is a congenital anomaly which is due to failure of closure of noto cord. There is swelling in the occipital region which contains displastic brain and CSF. Antenataly can be diagnosed by Ultrasound. CT scan and MRI of the brain tell us about the sac, it contents and any abnormality of the brain. Surgical intervention is the best option of treatment and outcome is excellent if operated on time. OBJECTIVES: To find out the outcome of surgical intervention in occipital encephalocele. MATERIAL AND METHODS: It is a descriptive study conducted in the department of neurosurgery JPMC Karachi from January 2009 to December 2009. Total patients were 22. All of them were operated. elleptical incision given and outcome detected. The information were conducted through a proforma including clinical finding and investigations like CT scan or MRI. The operation finding and outcome were noted. All patients came with recurrence were excluded. Data was analysed using SPSS 10 version. RESULTS: We have 22 patients male were 6 and females were 16. The age was managing from 04 days upto 1½ years maximum of patients in age 2 months. eighteen patients born in hospital while 4 born at home. Anterior Fontale (AF) were open in 18 patients. There was hydrocephalus (HCP) in 8 patients. Post operatively in 2 patients there was cerebrospinal fluid (CSF) leakage and 4 patient have HCP. only one patient expired. CONCLUSION: Occipital encephalocele is a congenital anomaly. It is more common in female outcome is excellent if operated in time. Key Words: Encephalocele, Hydrocephalus, CSF leakage.

CONCLUSION: Our results support that early decompressive craniotomy of traumatic contusions not only reduces the brain edema but also aids in early recovery. KEY WORDS: Decompressive craniotomy, head injury, Glasgow coma score.

OUTCOME OF SPINAL MENINGIOMAS AND NEUROFIBROMAS
DR. SHAMSHER ALI, DR. LAL REHMAN, PROF. A. SATTAR M. HASHIM. Department of Neurosurgery Jinnah Postgraduate Medical Centre, Karachi INTRODUCTION: Spinal tumors are divided into extradural and intradural, and intradural tumors may be intradural extramedullary of intradural intra medullary. Meningiomas and neurofibromas are intradural and extra medullary but very rarely the neurofibroma may be extradural as well. These patients present with backache, weakness in the limbs and sphincters involvement. Meningiomas are more common in female and also dorsal spine. MRI is the investigation of choice. Surgery is the best option of treatment. Most of the patients improve neurologically after surgery. This study was conducted in the department of neurosurgery JPMC Karachi to know about the importance of surgery in these tumours because their surgery is easy and the outcome is excellent. OBJECTIVES: To find out the neurological out come of spinal meningiomas and neurofibromas after neurosurgical intervention. Methodology: It is a descriptive study conducted in the department of neurosurgery JPMC Karachi from April 2008 to October 2009. Total patients operated were 22. Both male and female patients of all age were included and patients with recurrent tumors were excluded. Data was collected with the help of proforma including the clinical features MRI findings, surgical intervention and out come of these patients. Data was analyzed with the help of SPSS version 10. RESULTS: Total 22 patients were operated for spinal meningiomas and neurofibromas. Out of these patients, 12 were cases of neurofibromas and ten patients had meningiomas. In neurofibromas, six were extradural and sex patients had intradural neurofibromas. The male to female ratio was 7:5 and three patients had cervical neurofibromas. In meningioma patients, 8 were females and two were males. Nine patients had dorsal meningiomas and one patient had meningioma at L1 level. There were no complications in the form of CSF leak, wound infection or neurological deficit. All of the patients improved neurologically. CONCLUSION: Spinal meningiomas and neurofibromas are intradural and extramedullary but neurofibromas may be extradural as well. Surgery is the best option of treatment. Outcome is excellent if these patients are operated in time. KEYWORDS: Spinal Tumour, meningioma, neurofibroma.

PAROXYSMAL DYSKINESIA, A RARE MOVEMENT DISORDER WITH INTACT CONSCIOUSNESS: A CASE REPORT
KAUSAR MEHMOOD, MUHD FAROOOQ, MOAZAMA SHAH, HIBA MAHMUD SHAUKAT ALI Department of Neurology Jinnah Postgraduate Medical Centre, Karachi OBJECTIVE: To present a case report of a patient with a rare movement disorder Paroxysmal Dyskinesia. METHOD: 12 year old female presented in out patient department of Neurology Ward with complains of multiple transient episodes of hemiplagia with side to side shifting since the age of three months and abnormal paroxysmal contractions of arms for last 1 year. Her examination shows hypotonia and hemiplagic gait. Video EEG monitoring showing mild slowing of background. Ig E Levels done at the age 4yrs were elevated.MRI with MRA was normal .A diagnosis of Paroxysmal Dyskinesia was made. CONCLUSION: Paroxysmal Dyskinesia, are a group of rare movement disorders characterized by attacks of hyperkinesias with intact consciousness, with many sub types.

DELIBERATE SELF HARM- GENDER BASED ANALYSIS IN TERMS OF AGE, INTENT AND MOTIVATION
SHAKILA ATIF 1, M. IQBAL AFRIDI 2 1 Postgraduate Trainee / 2 Head of the Department Department of Psychiatry Jinnah Postgraduate Medical Center, Karachi BACKGROUND: Traditionally rates of suicide and DSH were low but over the past few years there has been a steady increase in these rates, so much so that it has become a major public health problem in Pakistan. It was strange to see that in a country with a population of approximately 162 million, no official data on suicide or DSH is available. It has been estimated that for every suicide there are at least 10 to 20 acts of DSH. Hence the need for this study was felt. OBJECTIVES: to see the motivation factors and intent behind an act of DSH in terms of age and gender. METHODOLOGY: This is a descriptive (case-series) study which was conducted at Liaquat National Hospital (LNH) in Karachi. Study duration was six months. Hundred consecutive patients of DSH were included. Non-probability sampling technique was applied. A structured questionnaire containing all personal information regarding age, gender, education, marital status etc and also special information regarding method and reason for DSH, intent and motivation behind the act, history of previous suicidal attempt if any, was administered to all patients after acquiring their consent. The data was entered and analyzed in the statistical package for social science (SPSS 10.00) for windows. Frequency and percentage was compiled to present all categorical variables like sex, marital status, occupation, education, reason for suicidal attempt, previous suicidal attempt and psychiatric diagnosis. Mean and standard deviation were computed for quantitative variables like age and years of marriage. RESULT: The sample of patients consisted of 56 % (n=56) females and 44% (n=44) males. Most of the cases (55%) were in the age category of 20 -39 years. 65% (n=65) stated family issues / problems to be the reason for DSH, 22 % (n=22) tried to harm themselves secondary to medical or psychiatric illness followed by 13% (n=13) who had financial issues and resorted to DSH. 74% (n=74) intended to die whereas for 26% (n=22) it was more of an impulsive act.

ROLE OF EARLY DECOMPRESSIVE CRANIOTOMY IN THE MANAGEMENT OF HEAD INJURY
ASIF A. QURESHI, A. SATTAR M. HASHIM Department of Neurosurgery Jinnah Postgraduate Medical Centre, Karachi OBJECTIVE: To see the results of decompressive craniotomy in the treatment of severe head injury. PATIENTS & METHODS: Medical record of 63 patients with head injury having either bifrontal or frontoparietotemporal contusions, who underwent decompressive craniotomy were reviewed. There were 55 male and 8 female patients. Patient’s mode of injury, type of injury, Glasgow coma score (GCS) score (pre and post operatively) and early outcome was analyzed in respect to timing of surgery after admission to neurosurgical care. Complications secondary to surgical intervention were also noted. RESULTS: Out of 63 patients, 55 had bifrontal contusions with severe brain edema, 5 patients had unilateral frontoparietotemporal contusions and 3 patient of post traumatic subdural empyema had gross midline shift. All patients had been operated upon within 24-48 hours on injury with marked improvement in GCS on first post op day. Early decompressive surgery resulted in recovery. Two patients developed dysarthria and 1 patient with left sided frontoparietotemporal subdural hematoma later on developed right sided hemiparesis.

91% (n=91) had no final act before the act of DSH against the 9% (n=9) who had made final acts. DISCUSSION: Females outnumbered men by 56%. This could be attributed to the fact that women in our part of the world usually have a low socioeconomic status. The study showed significantly higher rates of DSH among young adults. This could be attributed to the fact that this is the age when new relations are made or broken with eventual bereavement problems. The participants cited a number of bio-psychosocial reasons for DSH. Troubled interpersonal relationships constituted the main reason for attempting suicide. 74% of all patients had clear intensions to die with female pre-dominance of 42 followed by 32 males. The rest of 26% had resorted to it as an impulsive act, or with the intention of putting one to sleep or to put pressure on someone. CONCLUSION: The young are particularly at risk. It is more prevalent in the females. Most of the patients resorted to this act due to family issues / problems and for most the intention was to die. KEY WORDS: DSH, suicidal intent, gender.

was assessed. 14 students were reported to have insomnia among 25 students. RESULTS: 50% of the students, fulfilling the criteria for the study gave consent to be interviewed & about 56% students were reported to have insomnia, as having difficulty in initiating sleep. CONCLUSION: My study substantially concludes that insomnia does exist among medical students, which has serious consequence for health & well being.

ASSESSMENT OF SEXUAL DYSFUNCTION IN FEMALE PSYCHIATRIC PATIENTS USING ANTIDEPRESSANTS REPORTING AT JINNAH POSTGRADUATE MEDICAL CENTRE, KARACHI: A PILOT STUDY
DR. SAIMA QURESHI, DR. M. IQBAL AFRIDI Department of Psychiatry Jinnah Postgraduate Medical Center, Karachi {E-mail: syma.qureshi@gmail.com} BACKGROUND: Sexual Dysfunction is a common occurrence and an underestimated problem in psychiatric patients. It is associated with disorders such as depression and anxiety. Antidepressants aggravate the pre-existing sexual dysfunction. This can lead to psychological difficulties or medication discontinuation. In our society, social taboos and feelings of shame and guilt surround sexuality because of which it is a highly ignored subject. OBJECTIVES: To determine the frequency and type of sexual dysfunction affecting female patients using various types of antidepressants. METHODOLOGY: A total of 25 female patients attending Out Patient Department (OPD) at the department of psychiatry, J.P.M.C were approached out of which 13 fulfilled the criteria for the study and 10 gave consent to be included in the study. A semi-structured questionnaire was applied which contained personal information, type of antidepressant being used and nature of sexual dysfunction. RESULTS: 76.92% of the females fulfilling the criteria for the study gave consent to be Interviewed out of which 60% had sexual dysfunction. 66.67% of these patients were using Selective Serotonin Reuptake Inhibitors (SSRIs) and 33.33% were using Tri Cyclic Anti-depressants (TCAs). 83.33% reported lack of sexual desire which was the most frequent complaint and 16.67% reported failure of genital response. CONCLUSION: Sexual Dysfunction can occur as a result of anti-depressant use, especially with SSRI use. Patients rarely talk about this problem due to social taboos surrounding this topic, and therapists are usually incapable of initiating conversation regarding it. Further studies are needed in this area in order to highlight it as an important component of mental health.

PATTERN OF CO-MORBID SUBSTANCE USE AMONG FEMALE PSYCHIATRIC OUT-PATIENT
M. IQBAL AFRIDI 1, ROZEEN DHARWARWALA 2 1Professor and Head of Department of Psychiatry, JPMC, Karachi 2Clinical Psychologist, The Mind Centre, Regent Plaza, Karachi BACKGROUND: To Assessment of substance use among female psychiatric patients is important in terms of treatment and outcome. The impact of female’s addictions is enormous on family especially in our socio cultural setup. OBJECTIVE: To assess the pattern of substance use in females with co-morbid psychiatric illness in outdoor setup. METHOD: All consecutive cases were taken from a local clinic. PLACE AND DURATION OF STUDY: Carried out at TMC (The Mind Centre), Karachi, over a period of 1years (2009). METHOD AND MATERIALS: The sample 396 female with, depression somatoform disorders, anxiety, phobia, sexual problem, addiction and infertility. All consecutive cases that presented for psychiatric help were included. After consent, patients were assessed in detail by a thorough History, Mental State Examination, Physical and lab investigations supported on a diagnoses by ICD-10 criteria. Results were analyzed through SPSS (version 12.00). RESULTS: Total 396 females (mean age + SD=34+9.19) were assessed. 72(18.18%) of them were with substance use. Most of them (58, 41.8) were married wile their mean age + SD was 39.4+14.14 years. The findings suggest that female take every type of addiction. The most common substance use was tobacco in the form of pan with tobacco (37.5%) followed by smoking (23.6%), and Niswar (22.2%). The rest were using other form of substance including benzodiazepines. The most common psychiatric co-morbidities were depression (41.6%), conversion (11.1%), and bipolar disorders (9.7%) CONCLUSION: Substance use as co-morbidity is quite prevalent among psychiatric patients especially among cases with affective and conversion disorders. KEY WORDS: Co-morbid Substance Use, tobacco, mood and conversion disorder.

SINGLE DAY POINT PREVALENCE OF PSYCHIATRIC MORBIDITY IN THE PSYCHIATRIC OUT PATIENT DEPARTMENT AT JINNAH POSTGRADUATE AND MEDICAL CENTRE - A PILOT STUDY
DR. HIBA TOHID, DR. M. IQBAL AFRIDI, DR. SONIA AFTAB Department of Psychiatry Jinnah Postgraduate Medical Center, Karachi {E-mail: tohid_84@hotmail.com} BACKGROUND: A usual Psychiatric Out Patient Department (OPD) at JPMC, receives approximately 200 to 250 patients each day. This number reflects on the burden on our society. It also however, indicates the frequency of several psychiatric illnesses thereby allowing us to review and modify our methods and approach at the OPD. OBJECTIVE: To determine the frequency of various psychiatric illnesses amongst patients visiting the psychiatric OPD on a single day at JPMC as point prevalence in order to organize future OPDs. METHODS: Patients visiting the Psychiatric OPD on a single day were included in this pilot study. Incoming patients were evenly distributed amongst the four functional OPDs where each room assessed between thirty to fifty patients. A verbal consent was obtained and the patients were evaluated psychiatrically. Data regarding the patients was recorded orderly in log books maintained at each of the clinics which served as a major data collection tool. RESULTS: A total of 192 patients were assessed in the OPD. Results showed that the three most prevalent psychiatric illnesses amongst the visiting patients were Bipolar Affective/Mood Disorder 25.0% (48 patients), Depression 22.9% (44 patients) and Schizophrenia 19.8% (38 patients) while other conditions such as Epilepsy, Schizoaffective Disorder and Obsessive Compulsive Disorder showed a prevalence of 7.3% (14 patients), 5.2% (10 patients) and 3.1% (6 patients) respectively. Several other conditions recorded as 'Miscellaneous' constituted the remaining bulk of the patients. The logbook data also revealed that 168 (87.5%)out of the total patient turnout came for a follow up while the remaining 24 (12.5%) were visiting for the first time.

INSOMNIA IN THE MEDICAL STUDENTS OF PUBLIC SECTOR MEDICAL COLLEGE KARACHI: A PILOT STUDY
DR. DAULAT RAM & PROF. M.IQBAL AFRIDI Department of Psychiatry Jinnah Postgraduate Medical Center, Karachi BACK GROUND: About one third of life is spent in sleep. Sleep is an active state, which is essential not only for our physical, mental, and social well being, but also for optimal cognitive functioning. When sleep is disturbed it results in functional impairment, i.e decreased vigilance, impaired decision making, reduced concentration, irritability, day time sleepiness, increased fatigue and difficulty in thinking clearly. OBJECTIVES: To determine insomnia in medical students of Sindh Medical College Karachi. METHODOLOGY. A total of fifty students were visited at S.M.C, out of them 32 students fulfilled the criteria (students above 18 years of age with out any history of organic illness, substance use, or psychiatric disorder), for the cross sectional study. 25 students gave consent to be included in the study. A questionnaire was applied, which was optional for consenting students and the nature of insomnia

CONCLUSION: Psychiatric illnesses constituting the bulk at the OPD need to be addressed extensively in our psychiatry curriculum and basic psychiatric training at the hospital. Moreover, the OPD should be equipped to the hilt in order to deal with these conditions.

information on the subject. KEY WORDS: Depression, Post graduate trainee, risk factors, developing country.

FREQUENCY OF ANTE-PARTUM DEPRESSION IN PUBLIC AND PRIVATE SECTOR
KHAN S.1, PERVEZ S.2, BATOOL B.1, IQBAL Z.1, MANSURI F.A.3 1Final Year Medical Student, 2Fourth Year Medical Student, 3Head of Department, Community Health Sciences Karachi Medical & Dental College, Karachi OBJECTIVE: To find out the frequency of ante-partum depression in public and private sector. MATERIAL & METHODS: It is a descriptive study: cross sectional type. The study was conducted in Karachi at Abbasi Shaheed Hospital, Nazimabad (Government sector), Liaquat National Hospital, Stadium road (Private sector) and Aga Khan Maternity Hospital; Karim-a-bad (Private sector).A sample of one hundred and fifty (150) subjects was selected. The survey was conducted by self-administered questionnaire comprising of questions regarding Depression, Gynecological, Obstetrical, History of Daily Interest, Medical, Emotional, Physical and Mental symptoms. All patients were made to fill one more questionnaire that is H.A.D. (Hamilton Anxiety Depression) scale of Abbasi Shaheed Hospital (Department of Psychiatric Medicine). After selection of subjects from the Hospital, their verbal consent was taken. They were asked questions and the questionnaire was filled after translating it to them in Urdu. RESULTS: The result of the study showed that in Abbasi Shaheed Hospital 23 (41.8%) out of 55 cases were in severe depression, In Liaquat National Hospital 14 (21.5%) out of 65 cases were in severe depression whereas in Aga Khan Maternity Hospital, 4 (13.3%) out of 30 cases were in severe depression. It also showed that 32.7% cases were diagnosed as mild depressive patient, while the ratio of moderate depression is 17.3%, severe depression is 28% and no depression is 22%. CONCLUSIONS: It was found that a great proportion of pregnant ladies attending either public/private sector hospital in Karachi experienced mild to severe depression. Females with severe depression were more prone to be belonging to low socio-economic group. Furthermore; our research showed that ratio of depression was high among maternal age group of 18-28 years as compared to older age group and was common among primi-para. It was also seen that house wives were more depressed during pregnancy as compared to working women.

ABUSE AMONG SCHOOL GOING ADOLESCENTS: IS IT ASSOCIATED WITH SCHOOL PERFORMANCES AND MOOD DISORDERS
SALEEM KHAWAJA* ADEEL AKBAR KHOJA,* KOMAL MOTWANI* ALI KHAN KHUWAJA** **Assistant Professor, Family Medicine/ CHS, Aga Khan University, Karachi, Pakistan *Medical Students, Dow University of Health Sciences, Karachi BACKGROUND: Abuse is a major public health problem among adolescents, globally. Adolescent’s mental and physical health, general well-being, and ability to become a productive adult, all are being affected by exposure to abuse. The objectives of this study were to assess the proportion of various types of abuses and their association with school performances and persistent sadness among adolescents in Pakistan. METHOD: This was a cross-sectional school survey of 314 adolescent students (age 13 to 17 years) conducted in four schools of Karachi and Quetta, Pakistan. Data was collected using the self-administered and pre-tested structured questionnaire. All the data was collected and managed by trained medical students. Chi-square test was used to calculate the association of various types of abuses with poor school performances and persistent sadness. RESULTS: In all, 30.9% participants were physically abused and 50.0% participants were verbally abused during the last 12 months. Over half of study participants (55.1%) were involved in physical fight and 45.5% adolescents had suffered with injury during the preceding year. Adolescents being bullied were 37.3% during the same period. Verbal abuse (p=0.05), physical fight (p=0.05) and bullying (p<0.001) were significantly associated with poor school performances among adolescents. While physical abuse (p=0.05), verbal abuse (p=0.003), injury (p=0.02) and bullying (p<0.001) were significantly associated with persistent sadness among adolescents. CONCLUSION: In this study, various types of abuse were quite prevalent in adolescents which are significantly associated with poor school performances and persistent sad mood. Further research is warranted to identify the causes of abuse among adolescents. Interventions at various levels are also recommended to prevent abuse among adolescents. KEYWORDS: Abuse, Adolescents, Pakistan.

DEPRESSION AND ITS ASSOCIATED RISK FACTORS IN MEDICAL AND SURGICAL POST GRADUATE TRAINEES AT A TEACHING HOSPITAL: A CROSS SECTIONAL SURVEY FROM A DEVELOPING COUNTRY DR. AISHA YOUSUF Family Physician Aga Khan University Hospital, Karachi BACKGROUND: Depression in doctors demands serious attention, otherwise inability to cope efficiently with the stress of education and work may lead to consequences at both personal and professional level. In recent years efforts geared towards counseling are becoming more common within hospital settings but unfortunately not for depression. And in case of doctors this may also affect patient care and lead to preventable medical errors. An extensive literature search revealed that there is a dearth of validated information on this subject. This study was therefore undertaken to determine the frequency of depression among post graduate medical trainees in a teaching hospital in Pakistan and to explore the associated factors contributing to depression in them. METHOD: A survey was performed in a tertiary care teaching hospital in Pakistan. Zung Self-Rating Depression Scale was administered among 172 post graduate trainees for screening depression and self administered questionnaires were used to assess the associated demographic and work related risk factors. Adjusted odds ratios (OR) were calculated by logistic regression. RESULTS: The survey response rate was 82.69%. Depression in the overall sample was 58.72%, out of which 33.66% were moderate to markedly depressed. Multiple logistic regression analysis revealed that working hours less than 76 hours (OR 3.71; CI=1.67, 8.23) and 76-90 hours (OR 3.15; CI= 1.42, 6.97) and none or occasional peer support (OR 2.05; CI=1.01, 4.18) were independent predictors for depression among the post graduate trainees. CONCLUSION: More than half of our sample population is depressed. Therefore, they should be encouraged to recognize and seek treatment. This study also indicates that less working hours and lack of peer support cause depression. We feel that depression among post graduate trainees is a relatively unexplored area and more studies should, therefore, be conducted to gather more validated

AN EARLY EXPERIENCE OF ENDOVASCULAR TECHNIQUES AT FIRST-EVER PUBLIC SECTOR UNIT AT JPMC-KARACHI
DR. ARSHAD ALI Assistant Professor Department of Neurosurgery Jinnah Postgraduate Medical Center, Karachi Endovascular Neurosurgery is a rapidly developing field for treatment of cerebrovascular diseases by minimal invasive techniques. Advancement in catheter technology and improvement in imaging quality with ever increasing experience in understanding of the vascular diseases has remarkably changed the clinical outcome of the patients. Despite being recognized as an established modality of treatment world over, this has not yet been made available to large sector of population in Pakistan. It is partly because of lack of awareness both among patients, their families and physicians and partly because of high level of cost for consumable items used for embolization. We at JPMC, Karachi started first ever public sector unit of neuroangiography a year ago and had done over 100 cases of both diagnostic and therapeutic neuro-intervention. This paper will only present our early experience of therapeutic cases of Neuro-intervention along with focusing on difficulties that came across to set up this unit. We will also concentrate how we are able to provide these services on a subsidized cost to poor patients with public-private partnership.

ROLE OF CLOWARD TECHNIQUE FOR CERVICAL DISC HERNIATION *DR. LAL REHMAN, DR A.SATTAR M. HASHIM
*Assistant Professor Department of Neurosurgery Jinnah Postgraduate Medical Centre, Karachi {E-mail: drlalrehman@yahoo.com} INTRODUCTION: Cervical disc herniation causes compression of the spinal cord and cervical nerve roots which lead to sign and symptoms accordingly. The patient presents with brachialgia, limbs weakness and other symptoms according to the extent of cord involvement. MRI is the investigation of choice. It helps in the diagnosis and planning for surgical intervention. There are many options for cervical disc resection and cloward procedure is one of them. Disc is removed

by drilling the disc with a cloward burr and a dowel graft from the iliac bone is inserted in the disc space followed by neck immobilization with collar. The prognosis is excellent if these patients are operated in time. This study was conducted to know about the effectiveness of cloward technique as it is simple and has good results. OBJECTIVE: To find out the outcome of cloward procedure in cervical disc herniation in terms of neck pain, brachialgia and neurological deficit in the limbs. STUDY DESIGN: Descriptive Study (Case – Series) PLACE AND DURATION OF STUDY: The study was conducted in Neurosurgery Department of Jinnah Post Graduate Medical Center, Karachi, from May 2008 to May 2009. PATIENTS AND METHODS: It was a descriptive study in 35 consecutive patients. These patients presented with neck pain, brachialgia, limbs weakness and spasticity. All patients were clinically examined for pre operative neurological status (assessed on the basis of power, reflexes and sensation), and Neuroradiological investigations included cervical spine X-rays and MRI. All patients were surgically treated for cervical prolapsed intervertebral disc with anterior cervical discectomy and interbody fusion with Cloward technique. Post operative neck immobilization done with the cervical collar for a period of 12 weeks. Drain removed on first postoperative day while check plain cervical X–Rays taken on third day. Recurrent disc already operated through smith Robinson’s method or through microdiscectomy were excluded. RESULTS: Among 35 patients, 29 were males and 6 females. Male to female ratio was 4.8: 1; mean age was 44.3 years while common age group was of 40 to 50 years. The commonest symptom was neck pain. The duration of symptoms ranges from 2 to 6 months. On MRI, prevalent levels of cervical disc prolapse were C 5- 6 (48.5%) and C 6 – 7 (22.8%). According to the MRI, 31 patients had disc herniation causing thecal effacement with cord compression and 04 patients showed ischemia of cord. Single level Cloward surgery done in 31 patients while two levels Cloward performed in 04 only. About 83.3% patients improved and 13.3% not improved, 01 patient was re operated. No complications and mortality was related to the surgical procedure. CONCLUSIONS: This study provides the evidence that, Cloward technique for cervical disc herniation is a relatively simple and safe surgical procedure with favorable results. Hundred percent fusions occur after Cloward surgery, even without instrumentation. The complications related to the cloward procedure are less. Early mobilization of patient and short hospital stay is also possible. It appears to be a safe alternative to currently used procedures. KEY WORDS: Cloward procedure,ÊCervical Spine Fusion and Cervical Disc Herniation

CAUSES OF TOOTH EXTRACTION AT A TERTIARY CARE CENTRE IN PAKISTAN
MUHAMMAD HASEEB, KAMRAN ALI, FAISAL MUNIR Dental Surgeon, Lahore {E-mail: dr.haseeb@gmail.com} OBJECTIVES: To document the causes of permanent tooth extraction. MATERIAL AND METHODS: It was a descriptive study conducted at department of oral and maxillofacial surgery, Punjab Dental Hospital, Lahore - Pakistan. 1026 patients were included in the study who were referred to the department of Oral Surgery for extractions of permanent teeth. Extractions for orthodontic treatment excluded. Oral hygiene was recorded using Simplified Oral Hygiene Index. RESULTS: Mean age of study population was 46.60 (S.D +11.321). 59.6% were males. Advanced dental caries was the leading cause of tooth extraction (52.5%), followed by periodontitis (26.2%), endo-perio lesions (10.6%), restoration failure (4.6%), trauma (3.2%) and miscellaneous local pathologies (2.9%). More than half of the patients (52.6%) had poor oral hygiene. CONCLUSION: Advanced dental caries is the most common cause leading to tooth extraction. KEY WORDS: caries, periodontitis, endo-perio lesions, tooth extraction, oral hygiene.

EFFECT OF EXTRACTION OF FIRST FOUR PREMOLARS ON SMILE ESTHETICS AFTER ORTHODONTIC TREATMENT
FARHANA GHAFFAR, MUBASSAR FIDA Orthodontics Section of Dentistry, Department of Surgery The Aga Khan University and Hospital Karachi INTRODUCTION: The objective of the present study was to assess smile esthetics after orthodontic treatment in subjects with and without extraction of first four premolars. MATERIAL AND METHODS: Post-treatment colored printed frontal photographs ( 4 × 6" ) of 30 subjects were assessed. For half of the patients ( n =15 ), treatment included the extraction of first four premolars, whereas the other half were treated without extractions. Smile esthetic parameters were measured with the help of seven variables and ratios amongst them were calculated in order to assess the change in smile esthetics in subjects treated with and without extraction of first four premolars. RESULTS: All seven variables and ratios amongst them, measuring smile esthetics in our study, namely smile width, smile height, visible dentition width, maxillary intercanine width, visible maxillary first molars, visible mandibular teeth and visible maxillary marginal gingiva showed no detrimental effects of extraction of first four premolars on smile esthetics. CONCLUSION: The effect of extraction and nonextraction treatment on smile esthetics were very similar, indicating that treatment involving the extraction of first four premolars does not have a detrimental effect on smile esthetics.

PROSTHODONTICS REHABILITATION OF DIABETIC PATIENTS
DR. MEHMOOD HUSSAIN Incharge Department of Prosthodontics Hamdard College of Medicine & Dentistry, Karachi {E-mail: ) Patients having Diabetes Mellitus are more prone to develop various systemic and oral lesions. Due to these oral lesions diabetic patients have problems in maintaining adequate oral hygiene as a result these patients have early loss of tooth / teeth which eventually leads to edentulous state. Prosthodontics is a branch of dentistry deals with replacement of missing tooth/ teeth with bio compatible material. In this paper oral features and Prosthodontics rehabilitation of diabetic patients is discussed.

DENTAL CARIES AND DIABETES MELLITUS: ROLE OF SALIVARY FLOW RATE AND MINERALS
MUHAMMAD JAWED1, SYED M. SHAHID2 AND ABID AZHAR2 1 Department of Biochemistry, Liaquat College of Medicine & Dentistry, Karachi, Pakistan 2 Dr. A. Q. Khan Institute of Biotechnology & Genetic Engineering (KIBGE), University of Karachi, Karachi, Pakistan INTRODUCTION: This study was designed to evaluate the possible protective role of salivary factors like salivary flow rate and adequate level of calcium, phosphate and fluoride in patients of diabetes mellitus type 2 against dental caries. MATERIALS & METHODS: A total of 398 patients of diabetes mellitus type 2 with dental caries and 395 age and sex matched non-diabetic subjects with dental caries were included as controls. All subjects were divided into four groups according to their ages. Decayed, missed and filled teeth (DMFT) were scored to indicate the severity of dental caries. Saliva was collected, flow rate was noted and calcium, phosphate and fluoride were analyzed. RESULTS: The FBS, HbA1c and DMFT indices were found to be significantly high in diabetic patients as compared to controls. The salivary flow rate, calcium, phosphate and fluoride were found to be significantly low where as no significant difference was found in salivary magnesium in patients as compared to controls. CONCLUSION: Optimum salivary flow rate is responsible for establishing protective environment against dental caries. Adequate level of salivary calcium,

SURGICAL APPROACH IN ORAL SUBMUCOUS FIBROSIS DR. ZUBAIR AHMAD ABBASI Associate Professor of Oral and Maxillofacial Surgery Karachi Medical and Dental College & Abbasi Shaheed Hospital Oral Submucous fibrosis is a chronic, fibrotic, pre-malignant condition of oral mucosa. It causes severe trismus and has potential for malignant transformation. Patient’s quality of life is severely effected and normal oral hygiene and dental care is nearly impossible in these patients. Incidence and complaints of OSF patients was audited for three months attending oral and maxillofacial surgery Dept. at Abbasi Shaeed Hospital is discussed. Surgical correction by local flap can give satisfactory result as far as mouth opening is concerned and patient’s quality of life can be improved. Rationale for tongue flap is explained and results of patients undergone surgery is presented.

phosphate and fluoride is also involved in significant deposition of these minerals in plaque which greatly reduces the development of caries in the adjacent enamel of teeth. KEY WORDS: Dental caries, diabetes mellitus, salivary flow rate, salivary minerals.

ANALYSIS OF P53 GENE MUTATIONS/POLYMORPHISMS IN ORAL SQUAMOUS CELL CARCINOMA (OSCC) IN PAKISTAN
SAIMA SALEEM1, ABDUL HAMEED2, MUHAMMAD AJMAL2, NAVID RASHID QURESHI3, ZUBAIR ABBASI4 AND ABID AZHAR1 1 Dr. A. Q. Khan Institute of Biotechnology and Genetic Engineering (KIBGE), University of Karachi, Karachi 2 Institute of Biomedical and Genetic Engineering, 24-Mauve Area, G-9/1, Islamabad 3 Liaquat College of Medicine and Dentistry, Karachi 4 Karachi Medical and Dental College, Karachi INTRODUCTION: Oral squamous-cell carcinoma (OSCC) is among the common neoplasm in Pakistan. Epidemiologic evidence indicates a direct relationship between tobacco smoking, chewing of betel leaves (paan), betel nut (chaliya), niswar and gutka, with oral carcinogenesis, suggesting that there may be specific genetic targets of betel-quid ingredients. The p53 gene has been indicated to be a tumor-suppressor gene that is found in mutated form in common human cancers. However, there are few reports about "carcinogen-specific" p53 mutation. MATERIALS AND METHODS: Tissue and blood specimens were collected from 250 OSCC patients, with informed consent, from local hospitals of Karachi and were used for p53 mutation analyses. Exons 4, 5 and 6 of p53 genes were examined by polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) and direct sequencing. RESULTS: The PCR-SSCP analyses showing mobility shift bands in tumor samples were purified and directly sequenced. In exon 4 of the p53 gene, a C to G missense mutation at nucleotide position 215 of the coding sequence was identified. CONCLUSIONS: This change substitutes amino acid proline with arginine at position 72 of p53 protein. The change was significantly observed in OSSC tumor sample that may be responsible for causing OSCC in Pakistan. KEY WORDS: p53, OSCC, PCR-SSCP, DNA sequencing, and mutation

APPLICABILITY OF THREE MIXED DENTITION ANALYSIS METHODS IN ORTHODONTIC PATIENTS AT AKUH
SARWAT MEMON, MUBASSAR FIDA Orthodontics, Section of Dentistry Department of Surgery The Aga Khan University and Hospital, Karachi INTRODUCTION: Mixed dentition analysis forms a crucial part of an early orthodontic evaluation and treatment planning. A review of orthodontic literature reveals variability in tooth size in different population groups. Therefore, it is important that prediction techniques should be interpreted relative to respective racial norms, since failure to consider tooth size and racial variations would render the interpretation of Moyers’ probability tables, Bernabé and Floris-Mir and Tanaka and Johnston’s prediction equations8 as misleading. Therefore the aim of my study is to observe agreement between actual sum of canine and premolars and that predicted from three mixed dentition prediction methods in orthodontic patients at AKUH. MATERIAL AND METHODS: Data were collected using pretreatment records including orthodontic files and plaster casts of 121 orthodontic patients 45 males, 76 female; average ages, 13.3 and 13.4years respectively. Digital caliper was used to measure the mesiodistal widths of permanent teeth from 1st molar to 1st molar in mandibular arch, and central incisors and 1st molars in maxillary arch. The methods of Tanaka and Johnston, Moyers, and Bernabé and FloresMir were used to predict the mesiodistal widths of the canine and premolars. Comparison between the actual and predicted sum of the mesiodistal widths of canine and premolars was made for each prediction method, using paired sample t-test. RESULTS: For males statistically significant differences were found for Moyers at the 75th percentile and Bernabé and Flores-Mir method whereas for females only the Bernabé and Flores-Mir’s method showed significant results. However no significant difference was found in both genders for Tanaka and Johnston method. CONCLUSIONS: In our orthodontic patients for males Moyers 50th percentile and Tanaka and Johnston methods while for females Moyers 75th percentile and Tanaka and Johnston methods can be applied for mixed dentition analysis.

DENTAL AGE TABLE FOR ORTHODONTIC PATIENTS AT THE AGA KHAN UNIVERSITY AND HOSPITAL KARACHI
*RASHNA FIROZE AGA, MUBASSAR FIDA Orthodontics, Section of Dentistry Department of Surgery The Aga Khan University and Hospital, Karachi INTRODUCTION: Demirjian’s dental age assessment method is used worldwide to assess a patient’s dental age. However this method was developed using French Canadian population standards and has shown significant differences in various populations. Therefore the aim of this study was to evaluate the applicability of the Demirjian’s dental age assessment table in orthodontic patients at the Aga Khan University and Hospital, and if not applicable, to formulate a separate dental age table for Pakistani boys and girls. MATERIAL AND METHODS: The study was conducted on a sample size of 438 subjects (180 males and 252 females) ranging in age from 7 to 17 years. Paired t-test was used to assess any difference between chronological age and dental age assessed according to Demirjian’s method. Linear regression with the equation Y=100/1+e⺠- â1X was used to generate dental age tables for Pakistani males and females. RESULTS: Dental age assessed according to Demirjian’s method for our male sample was over-predicted in the age group 11 – 15 years (p < 0.05). In our female sample there was an over-prediction in the age group 10 – 14 years and under-predicted in age groups 16 and 17 years (p < 0.05). CONCLUSIONS: Statistically significant differences were found in the chronological age and dental age assessed by Demirjian’s method for our study sample and thus a new table was generated to convert dental maturity calculated according to Demirjian’s method into dental age for our patients.

MAXILLARY ARTERY PERFORATING INFERIOR ALVEOLAR NERVE: AN ANATOMICAL STUDY
MUHAMMAD MUJAHID KHAN Associate Professor Department of Anatomy, College of Medicine King Saud University, Saudi Arabia {E-mail mm@ksu.edu.sa / dralkhan@hotmail.com} The infratemporal fossa is a clinically significant anatomical area for the delivery of local anesthesia in the practice of dentistry and maxillofacial surgery. A study of the infratemporal fossae in Caucasian cadavers was conducted and the topographical relations of the inferior alveolar nerve with the maxillary artery were studied. In 3 out of 50 fossae dissected, the maxillary artery passed through the inferior alveolar nerve, splitting it into superficial and deep divisions. Entrapment of the maxillary artery may cause numbness or headache and may interfere with injection of local anesthesia in the infratemporal fossa.

OUTCOME OF HIP RECONSTRUCTION OSTEOTOMY
*HASNAIN RAZA, HAROON UR RASHID, MASOOD UMER *Resident Orthopedic The Aga Khan University, Karachi BACKGROUND: Instability of the hip joint can be secondary to congenital pathologies like dysplatic dislocated hips (DDH) which are neglected and proximal femoral focal deficiency or acquired such as sequele of infective or neoplastic process. An unstable hip is usually associated with loss of bone from the proximal femur, proximal migration of the femur, lower-extremity length discrepancy, abnormal gait, and pain. In this study we report our results in the treatment of the unstable hip joint by hip reconstruction osteotomy using the Ilizarov method. This includes an acute valgus and extension osteotomy at the proximal part of the femur combined with gradual distraction for realignment and lengthening at a second, more distal, femoral osteotomy. OBJECTIVE: To review our clinical results of hip reconstruction osteotomy by Ilizarov method for unstable hip joint. METHOD: It is a case series of 16 consecutive patients who underwent hip reconstruction osteotomy for unstable hip at The Aga Khan University Hospital, Karachi between May 2005 and July 2008. Six males and 10 females were operated with an average age of 21yrs at time of surgery. Seven left sided hips, eight right sided and one bilateral were operated. They have various etiologies, six hips were diagnosed as neglected dysplatic dislocated hips(DDH), six were sequele of septic arthritis, 2 had history of tuberculous arthritis and one case of Giant cell tumour of femur head and proximal femoral focal deficiency each. Outcomes were evaluated clinically by Harris hip scoring system. RESULTS: At the time of follow-up, at a mean of 23 months, the post operative Harris hip score was significantly improved as compared to preop. Mechanical alignment and equal length of lower extremity were achieved in almost all cases. CONCLUSION: The Ilizarov hip reconstruction can successfully correct a Trendelenburg gait by stabilizing the hip and supporting the pelvis and simultaneously restore knee alignment and correct lower-extremity length discrepancy.

PLACE AND DURATION OF STUDY: Department of Orthopaedic Reconstructive and Hand Surgery, Jinnah Medical College Hospital and Department of Orthopaedics, The Indus Hospital Karachi, from November 2004 to August 2009. METHODS: Five patients with circumferential degloving hand injuries requiring coverage with a paired lower abdominal flap were included. Three patients underwent paired flap while two refused flap coverage and opted for coverage with full thickness skin graft. The surgical technique is diagrammatically represented. Overall hand function was evaluated through Quick DASH questionnaire. RESULTS: Outcome assessment revealed satisfactory cosmetic and functional recovery with paired abdominal flap. CONCLUSIONS: We recommend this flap for mutilating hand injuries. It can be easily learnt by a well trained orthopaedic or plastic surgeon for salvage of hand in centres with limited microsurgery facilities. KEY WORDS: Hand sandwich; Paired abdominal flap

SHORT TERM RESULTS OF LIGAMENT RECONSTRUCTION WITH TENDON INTERPOSITION FOR CARPOMETACARPAL (CMC) JOINT ARTHRITIS
KASHIF ABBAS, PERVAIZ HASHMI Resident Orthopedic Surgery Aga Khan University Hospital, Karachi INTRODUCTION: Carpometacarpal joint of the thumb is the second most common site afflicted by osteoarthritis. Non surgical measures forms the first line of treatment with aim of preventing progression of disease, however, surgery becomes an option when symptoms are refractory to nonsurgical methods. Different procedures have been described in literature. Ligament reconstruction with tendon interposition (LRTI) is the most commonly performed procedure in North America for this problem. OBJECTIVES: Aim of study is to evaluate early results of ligament reconstruction and tendon interposition for CMC joint arthritis MATERIAL AND METHODS: Case series of 10 cases done at a tertiary care hospital from 2006 - 2008 Dec. All cases were operated by a single surgeon. These patients were followed up using Quick DASH questionnaire. RESULTS: All patients were female. Mean duration of follow up 18 months. Pain and residual laxity recorded at each clinical follow up visit after removal of thumb spica and Kirschner wire. Mean value for Quick DASH score is 31 in a 0 – 100 scale with 0 being no disability. CONCLUSION: Ligament reconstruction and tendon interposition resection arthroplasy is an effective method of controlling symptom with preservation of motion at CMC joint axis.

PELVIC DISSOCIATION IN REVISION TOTAL HIP ARTHROPLASTY: DIAGNOSIS AND TREATMENT
Shahryar Noordin Pelvic dissociation is a distinct but uncommon condition, which occurs in association with total hip arthroplasty, in which the superior aspect of the pelvis is separated from the inferior aspect by fracture. Because radiodense implants and cement can obscure pelvic discontinuity on plain radiographs, not all dissociations can be diagnosed preoperatively; therefore, a high index of suspicion for this condition should be maintained. In selected patients, CT angiography may be indicated. Successful treatment requires achieving initial stability of the socket, establishing conditions for long-term stability of the socket, stabilizing the pelvic dissociation, and producing conditions favorable for healing. Applying a posterior pelvic reconstruction plate to the ilium and ischium will achieve stabilization of the dissociation in most patients if sufficient posterior wall and column are present. Occasionally, if there is adequate space, a second plate may be applied. In selected patients, it may be feasible to place anterior column fixation screws using image guidance, rather than the alternate option of using anterior column plating through an anterior exposure. Residual bone loss is then reevaluated and possible options such as a hemispherical socket, a jumbo cup, or a highly porous metal component and augment can be considered. If there is not enough room for a posterior pelvic reconstruction plate, a cup-cage construct with or without an allograft can be used as a reconstruction option.

CONCURRENT CHEMORADIATION WITH OR WITHOUT CISPLATINUM AND GEMCITABINE BASED INDUCTION CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER
MUTAHIR ALI TUNIO1, ALTAF HASHMI2, ABDUL QAYYUM3, MANSOOR RAFI1 1Radiation Oncology, 2Urology, 3Medical Oncology Sindh Institute of Urology & Transplantation, Karachi BACKGROUND: Radical cystectomy is the gold standard treatment for muscle invasive bladder cancer. Over last decade much enthusiasm has been exerted on bladder sparing therapy. We evaluated the benefit of induction chemotherapy followed by concurrent chemoradiation as bladder sparing therapy in muscleinvasive bladder cancer. MATERIALS & METHODS: During Mach 2006 to April 2007, patients with T2T4bN0M0 bladder cancer underwent complete transurethral resection followed by Arm A: induction chemotherapy (cisplatinum+ Gemcitabine) q 28days four cycles followed by concurrent chemoradiation and Arm B: concurrent chemoradiation. Radiotherapy was given with shrinking field technique with total dose 6500 cGy with weekly cisplatinum or Gemcitabine. Patients were followed at 4weeks after radiation then every 3 months for any local recurrence or distant relapse. RESULTS: Among 45 patients (mean age 60.6 years), 23 and 20 patients in arms A and B completed treatment, respectively. In arm A, 20 patients (86%) achieved complete response (CR), out of 3 patients who did not achieved CR, 2 underwent salvage cystectomy. In arm B, CR was seen in 18 patients (90%); 1 patient underwent salvage cystectomy. During 25 months follow up period, local recurrences were seen in 3 and 4 patients and distant metastasis were seen 2 and 3 patients in arm A and B respectively. 2 year survival and progression free survival were 65.2% & 60%; 78.2% & 65% in arms A and B respectively. Of 27 surviving patients, 23(85.2%) are retaining intact bladder functions. CONCLUSION: TUR followed by sequential induction chemotherapy and chemoradiation showed improves disease free survival without any impact on survival. However further follow up is required.

PAIRED ABDOMINAL FLAP: A RELIABLE HAND SANDWICH FOR DEGLOVING HAND INJURIES
SYED KAMRAN AHMED, SADAF SAEED, MUHAMMAD AMIN CHINOY, MANSOOR ALI KHAN Department of Orthopaedic, Reconstructive and Hand Surgery Jinnah Medical College Hospital & Department of Orthopaedic The Indus Hospital Karachi, Karachi INTRODUCTION: Despite the sophistication in microsurgical techniques, wound coverage for an entirely degloved hand remains a substantial challenge. The paired lower abdominal flap described by Miura and Nakamura provides simultaneous and adequate coverage for the dorsal and volar surfaces of an entirely degloved hand. It has been largely under utilized despite its extreme usefulness. OBJECTIVES: To justify the usefulness of paired abdominal flap in circumferential degloving injuries of the hand. STUDY DESIGN: Case series with review of literature.

H Y P O F R A C T I O N AT E D S C H E D U L E O F PA L L I AT I V E RADIOTHERAPY IN THE MANAGEMENT OF GROSS HAEMATURIA OF INVASIVE BLADDER CANCER PATIENTS
DR RAFIA TOOR1 & DR MUTAHIR A TUNIO2 Atomic Energy Medical Centre, JPMC, Karachi1 Oncology Unit, Sindh Institute of Urology and Transplantation, Karachi2 PURPOSE: To evaluate the efficacy of hypofractionated radiotherapy schedule for the improvement of local symptoms in patients of advanced, recurrent or metastatic urinary bladder cancer with the aim of palliation. Conventional radical radiotherapy was inappropriate because of extensive disease, poor general condition of the patients from muscle-invasive bladder cancer. METHODS AND MATERIALS: Ten patients of tumor status (pT1- pT4, N+, M0,1), were selected for the trial with gross haematuria due to progressive disease (ECOG 3,4) and 21 Gy in 3 fractions were delivered on alternate days for symptomatic improvement in patients considered unsuitable for curative treatment through disease stage or comorbidity. Baseline investigations include Heamoglobin, Urine C/S, Urea, Creatinine and imaging. The primary outcome measures were overall symptomatic improvement of bladder-related symptoms at 6 weeks and changes in bladder- and bowel-related symptoms from pretreatment to end-oftreatment assessments. Overall improvement was defined prospectively in gross haematuria, with no deterioration in any other bladder-related symptom. RESULTS: Presently 10 patients were recruited, but data on symptomatic improvement was available on 8 patients. Median age: 65 years, median survival 3 months. Questionnaire regarding the Quality of Life (QoL) filled by the patients after 6 weeks of radiotherapy. Of these, 40% achieved symptomatic improvement with minimum stress to the patient and acute side effects. CONCLUSION: This is a prospective trial to date in the palliative treatment of bladder cancer. The use of 21 Gy in 3 fractions (700cG each) regime appears effective and generally well tolerated on an outpatient basis for this frail poor prognosis group. Haematuria is particularly palliated with improving patient quality of life and decreasing workload on the radiation unit.

physicist performs an important role working along with the radiation oncologist, the radiotherapy technologists and others, to assure the accurate delivery of all aspects of a treatment prescription. The modern computer based radiotherapy technology warrants the adequate basic and technical knowledge of physicists to assure proper quality treatment. METHODS & MATERIALS: The physicists working in different radiation oncology departments were asked to share their knowledge about basic medical, clinical, radiobiology, scientific journal access and technical issues. The possible controversies were resolved by telephone conversations. RESULTS: Among 22 radiation oncology centers, wide variation was found in terms of basic clinical and radiobiology knowledge, journal access which will be discussed. They were found good in the equipment usage and program operations what were available in respective center. Two centers were found in which physicists see patients along with radiation oncologists for side effects during weekly follow up protocol, so can revise their treatment plans. Better collaboration was seen between physicists and radiation therapy technologists among all centers. CONCLUSIONS: Regardless of the employment situation and tools available, the physicist should be an active participant in discussions, planning, and decisions, particularly pertinent for physics involvement include: patient treatment techniques and planning, the physicists’ relationships to institutional personnel, negotiations for equipment and equipment acceptance testing and performance verification.

BREAST CANCER HISTORY TO, TODAY
NOOR SOOMRO, SAUD BALOCH. NASEEM FATIMA, MOHINI RAJ, SAEED QURESHI To discuss on Breast cancer from ancient age till today. In this Presentation we want to acknowledge the history of origin of world “cancer where it shows in history that there was no treatment. This Presentation includes updates of Surgery, radiation and chemotherapy. What are the major breakthroughs in the history and in what dimensions the researches are going on. Finally we will highlight our own scenario regarding protocols of breast cancer.

COMPARISON OF THREE METHODS FOR SKIN MARKINGS IN CONFORMAL RADIOTHERAPY, TEMPORARY MARKERS, AND PERMANENT STERITATT CIVCO ® TATTOOING: PATIENTS' COMFORT AND RADIOGRAPHERS' SATISFACTION
MANSOOR RAFI, MUTAHIR ALI TUNIO, ALTAF HASHMI Sindh Institute of Urology & Transplantation (SIUT), Karachi BACKGROUND: Skin marking is routinely performed at the time of simulation before radiotherapy treatment. Worldwide different methods are used to mark the isocenter; most commonly used are temporary marker pens, commercially available tattooing needles pre-filled with non toxic India ink (Steritatt CIVCO®) and henna. The aim of this study was to compare these three different methods in the terms of durability, repetition of marking session, any allergic reactions, patient comfort and radiographer satisfaction. MATERIALS AND METHODS: Sixty patients with early prostate cancer were selected who were due to undergo radiation for eight to nine weeks duration. At the time of simulation, the participants' skins were marked by one of the three methods: temporary marker pens, henna, and Steritatt CIVCO® needling. The patients were evaluated for the durability of markings, number of times the markings were repeated and allergic reactions. The patients' comfort was assessed by using a scoring system: they were asked to assess the method of the marking used. A rating scale was used: 1 = happy with marking method, 2 = seeking an alternate option. The radiographers were asked to score one of the methods using a scale 1-3: 1 = better, 2 = comparable, 3 = worse. RESULTS: Mean duration of the skin markings was four days (2-5), 18 days (1027) and 40 days for temporary marker pens, henna, and Steritatt CIVCO® needling, respectively. Patients with henna and permanent markings were equally satisfied with the less number of repeated markings. However radiographers were unsatisfied with henna because of the prolonged drying period (mean = 15 minutes). No skin allergies were seen in any procedure. CONCLUSION: Permanent markings remain the standard for a radiotherapy unit, patients and radiographers. Although patients were happy with the henna markings it is not recommended due to prolonged drying period and the need for repeated skin markings

SAFETY AND TOLERABILITY OF FOLFOX, 4 IN THE ADJUVANT TREATMENT OF COLON CANCER IN OUR POPULATION
HEERANAND, AHMED USMAN, KHALEEL MAHER Department of Clinical Oncology Jinnah Postgraduate Medical Centre, Karachi AIM: The MOSAIC trial showed that FOLFOX 4 improves over all survival as compared to 5-FU/LV and infeasible and safe in early stage colon cancer patients worldwide. Based on these positive results, we decided to conduct a study to evaluate the safety and tolerability of FOLFOX4 in postoperative adjuvant treatment of colon cancer in our local population. METHOD: In this open-label ,non randomize ,single arm feasibility study ,stage II/III colon cancer patients who had undergone complete resection of a primary tumor were treated using the FOLFOX4 regimen [2weeks /cycle,12cycles] and followed up for 8 months. RESULT: A Total of 37 patients [11 patients Stage II and 26 stage III] referred to us from different hospitals were included in the study .Overall 28 patients completed all 12 planned treatment cycle. The incidence of stage 3 and 4 neuropathy was 5.7 and 0 respectively. A Total of 9 serious adverse events [SAE] were experienced by 4 patients. . At 8 months follow-up, one patient had relapse or recurrence. CONCLUSION: The study demonstrates a favorable safety profile of FOLFOX4 in our patient population. Based on these results FOLFOX4 may be considered a standard for the adjuvant treatment of colon cancer. KEY WORDS: 5-Fluorouracil, colorectal cancer, folfox4, leucovorin, oxaliplatin,

CONCURRENT CISPLATIN BASED CHEMORADIATION FOR LOCALLY ADVANCED HEAD AND NECK CANCERS: EXPERIENCE AT KIRAN
SYED AMIR MAQBOOL, CONSULTANT CLINICAL ONCOLOGIST Karachi Institute of Radiotherapy and Nuclear Medicine, Karachi BACKGROUND: Head and neck cancer is a common malignancy in Pakistan. Most of them present in locally advanced stage. For locally advanced head and neck cancers, concurrent chemoradiation is most common option. We are presenting this study to determine the benefit concurrent chemoradiation in locally advanced head and neck cancers in our patients.

ROLE OF MEDICAL PHYSICIST IN RADIATION ONCOLOGY
ASAD ZAMEER, SHOUKAT ALI, ZAEEM AHMED, MUTAHIR A. TUNIO *Department of Radiation Oncology Sindh Institute of Urology and Transplantation (SIUT), Karachi BACKGROUND: A radiation oncology physicist brings a unique perspective to the clinical team in a radiation oncology department: that of a scientist trained in physics and also in clinical, basic medical and radiobiological sciences. The

MATERIALS & METHODS: During January 2009 to December 2009 patients with locally advanced head and neck cancer, underwent concurrent chemoradiation with weekly Cisplatin 100mg/m2 on Day1, 22 and 43. Radiotherapy was given with 3-DCRT technique, total dose 6600 cGy in 33 fractions. Response was defined using recist criteria on clinical exam, laryngoscopy and CT scanning. Toxicity was assessed using NCI-CTC criteria. RESULTS: Among 30 patients, 23 patients completed CCRT of whom visible complete response (CR) was seen in 55% patients and partial in 18% patients, stable disease in 5% of patients 22 % of patients had progressive disease. No grade III or grade IV hematological toxicity seen. CONCLUSION: Concurrent chemoradiation is very effective and well tolerated modality for locally advanced head and neck cancers.

The Aga Khan University Hospital Karachi In the past, blast injuries were usually associated with conventional warfare or unintentional accidents occurring in the workplace or at home. Bomb blast injuries to civilians in a non-combat setting have become increasingly common over the last decade, mainly as acts of terrorism. It is important to have an understanding of explosives and explosive forces to understand the types of injuries that these devices are capable of. Blast injuries cause 4 distinct types of injuries; Thermal injuries from explosions are classified as quaternary blast injuries; may cause flash burns over exposed body parts (e.g., hands, neck, and face) or inhalational injury with exposures of toxic substances such as asbestos dust, carbon monoxide, cyanide, white phosphorus, and phosgene gas in cases of confined space explosions. Burned patients are probably the sickest patients a physician will ever see. Effective management of these thermal injuries associated with primary blast injury, particularly blast lung injury, may be challenging due to conflicting fluid requirements. The management of multidimensional burns patient, complicated by other injuries, is a particular challenge, with implications in anaesthesia, acute pain, intensive care and patient transfer services areas. The anesthesiologists’ Knowledge of physiology and pharmacology and their ability to resuscitate critically wounded patients put them in the front line in a major explosion incident. As their training and experience, are well-adapted to the early management of all these forms of trauma, particularly in providing life-support stabilization for physical trauma, and their understanding of the detailed physiology and pharmacology of the respiratory, cardiac, and nervous systems makes them an integral part and valuable member of disaster management and planning team. Anaesthetists’ involvement for mass casualty includes a forward deployment of anaesthesiologists to emergency department (ED) together with ED physicians and surgeons are crucial. The anaesthesiologist’s ability to manage the airway, initiate mechanical ventilation, administer fluids, insert intravenous and arterial catheters, and treat shock and manage pain is important in the setting of burn patients of blast injury.

MANAGEMENT OF PAIN DUE TO POLYTRAUMA IN BOMB BLAST
BRIG. M. SALIM Professor of Anaesthesiology Trauma is a major cause of mortality throughout the world. In recent years, major advances have been made in the management of trauma, the end result of which has been reduced mortality and enhanced function. One of these areas is pain control. Improved pain management has not only led to increased comfort in trauma patients, but has also been shown to reduce morbidity and improve longterm outcomes. The treatment of pain in the setting of acute injury and on pain management in trauma patients who go on to develop chronic pain. Emphasis is placed on pharmacologic interventions, invasive and noninvasive pain management techniques, analgesia in challenging patients, and pain control in commonly encountered trauma conditions. Over the past two decades, researchers have discovered that the persistence of severe, inadequately treated pain can lead to anatomic and physiologic changes in nervous system The ability of neural tissue to change in response to repeated incoming stimuli, a property known as neuroplasticity, can lead to development of chronic, disabling, neuropathic pain when acute pain is poorly treated .The stress response after multiple trauma is far greater than that after elective surgery. KEYWORDS: Pain Management, Trauma Patients, Chronic Pain, Pharmacologic Interventions

ANAESTHETIC MANAGEMENT OF CARDIO THORACIC INJURIES DUE TO BOMB BLAST
PROF. NAJMA AMJAD Head of the department Anaesthesiology & Intensive Care National Institute of Cardiovascular Diseases, Karachi Blast injuries caused by powerful explosion have occurred at a relatively steady rate all over the world, often caused by home or work place accidents. Today explosions due to intentional/suicide bombing is the most common cause of injury associated with terrorism affecting the general population, particularly in our part of the world. Blast victims often show a combination of 4 main groups of trauma: (1)ÊBlast, (2) Blunt, (3) Penetrating, (4) Thermal. There are four basic mechanisms of blast injuries: (i)ÊPrimary - direct effect of pressure, (ii) Secondary - the effect of projectiles from explosion, (iii) Tertiary structural collapse, and (iv) Quaternary - burn and inhalation injury. In a report following a suicide bombing in a mosque, the pattern of injuries were as follows. Rupture of tympanic membrane 41%, chest injury 40%, shrapnel wound 36%, fractures 18%, head trauma 12%, and abdominal injury 5%. Cardiac thoracic injury accounts for at least 40% of injures due to bomb blast. Despite being potentially life threatening, most thoracic trauma is managed non operatively, with a chest tube. only 10 % of these patients requires emergency thoracotomy. Some of the pertinent cardio thoracic injuries due to bomb latest are:Ê Tracheo bronchial injuries, haemo thorax, pneumo thorax Êpulmonary Êcontusion, flail chest, blast lung, diaphragmatic injuries, cardiac contusion, penetrating cardiac injury with cardiac tamponade, great vessel injury. e,g aortic injury. Anaesthesiologist`s knowledge of physiology, pharmacology and their ability to resuscitate critically wounded patients, puts them in the front line in a major explosion incident. Cardio thoracic blast injuries are dynamic and it is crucial Êfor an anaestheiologist to provide care to this group of Êpatients, in expanded Êrange of scenarios and environments, starting Êfrom initial resuscitation and optimization, anaesthetizing for emergency thoracotmy or damage control surgery and management of these patients, post operatively in intensive care. KEY WORDS: BLAST LUNG injury, damage control surgery, rapid sequence induction, double lumen tube, major haemorrhage.

BATTLEFIELD ANESTHESIA
DR FAZAL HAMEED KHAN Mohammad Bhai Professor of Anesthesia Medical Director and Associate Dean Clinical Affairs The Aga Khan University Hospital Karachi Battlefield anesthesia primarily describes a state of balanced anesthesia using adequate amounts of anesthetic agents to minimize cardiovascular instability, amnesia, analgesia, and a quiescent surgical field in a technologically difficult environment. Adapting anesthetic techniques to battlefield conditions requires flexibility and a reliance on fundamental clinical skills. While modern monitors provide a wealth of data, the stethoscope may be the only tool available in such environment. Thus, the value of crisp heart sounds and clear breath sounds when caring for an injured war wounded person should not be underestimated. In addition, close collaboration and communication with the surgeon is essential The practice of battlefield anesthesia is very different from that of civilian’s anesthesia. Battle casualties are usually young men without pre-existing diseases, and their injuries are often markedly different from those of civilian trauma patients .The injuries reflect the ever developing arsenal used on present day battlefields and may include missile fragments, which cause severe trauma because of their irregular shape ,size and trajectory in the body, and high velocity gun shots, which have increased wounding power .Other physical injuries include burns, blasts, blunt injuries, inhalation of toxic fumes and the threat of non-conventional chemical injuries. Additionally,a field hospital should be ready to care for traumatised patients of all ages. Casualties often arrive en masse, dictating fast and careful establishment of resuscitation and surgical priorities. The improving techniques of anesthesia, operations and transport system have augmented the number of critically injured patients being resuscitated, thus increasing the challenge of battlefield anestheia.

MANAGEMENT OF BURNS DUE TO BLAST INJURYANAESTHETIST’S CONTRIBUTION
DR MUHAMMAD QAMARUL HODA Professor Department of Anaesthesia

CHALLENGES FACED BY THE ANAESTHETIC TEAM IN POLYTRAUMA DUE TO BOMB BLAST
BRIG. ASIF GUL KAYANI Head Department of Anaesthesiology Combined Military Hospital (CMH) Bahawalpur In a bomb blast situation the trauma management team faces unique challenges. There may be a mass casualty scenario involving high morbidity and mortality. In addition to the obvious effects of major trauma, patients can have serious multi organ damage due to the blast wave resulting in ‘blast injuries’. Blast injuries result from the complex pressure wave generated by an explosion. Air-filled organs (e.g. ear, lung, and gastrointestinal tract) and organs surrounded by fluidfilled cavities (e.g. brain and spinal cord) are particularly susceptible to primary blast injury. The pressure wave dissipates quickly, causing the greatest risk of injury to those closest to the explosion. Injuries can also occur by other mechanisms due to a blast, e.g. impact from blast debris, being physically thrown, burns and inhalation of gases. Blast injuries are divided into 4 categories: • A primary blast injury is caused by the direct effect of blast overpressure on tissue. The injury almost always affects air-filled structures such as the lung, ear, and gastrointestinal tract. • A secondary blast injury is caused by people being hit by flying objects. •A tertiary blast injury is caused by high-energy explosions and occurs when people fly through the air and strike other objects. •Miscellaneous blast-related injuries include all other injuries caused by explosions, e.g. due to fire or collapse of buildings. PRESENTATION • Lungs may show evidence of pulmonary trauma and . Wheezing may be due to pulmonary contusion, inhalation of irritant gasses or dusts, or (ARDS). • Rupture of tympanic membrane may but not always indicate additional more serious injury. • Abdominal injuries from explosions may not be immediately obvious and serial examinations are often required. Intestinal haematoma can take 12-36 hours to develop. Abdominal x-ray (erect and supine) or CT to detect pneumoperitoneum. OTHER ASSOCIATED COMPLICATIONS • Injury to the renal tract. • If the explosion occurred in an enclosed space or was accompanied by fire, test carboxyhaemoglobin () and electrolytes to assess acid-base status. • If significant , , or severe burns, may cause and myoglobinuric . • Burns from military white phosphorous munitions may cause and . White phosphorus is a widely used component of military munitions, including hand grenades. • Chest x-rays are required for all those who have been exposed to high-pressure injury. MANAGEMENT: The Anaesthetist Team should be physically and intellectually ready to handle a highly demanding situation. Anaesthetists’ help may be required in pre-hospital management but usually has to play a vital role in resuscitation and peri-operative management within the hospital.

MANAGEMENT OF MAJOR HAEMORRHAGE IN POLYTRAUMA
PROF. SAEEDA HAIDER Chairperson, Department of Anaesthesiology Surgical Intensive Care & Pain Management Dow University of Health Sciences, Karachi Trauma has become the leading cause of death specially in the younger population world wide. Uncontrollable haemorrhage accounts for 40% of trauma related deaths which is a potentially preventable cause. Coagulopathic bleed adding on to the Surgical vascular injury is multi-factorial, “Bloody vicious cycle” and the “Lethal Triad” result in fatal exsanguination. Combined Strategy of “Damaged Control Surgery” and judious management of replacement of fluids & blood components formulate the contemporary approach to this clinical issue. Re-evaluation of transfusion practices and understanding of the end points of resuscitation improve outcome in polytrauma.

TRANSPORT OF PATIENTS FROM THE BOMB BLAST SITE
DR AKHTAR AZIZ KHAN The Indus Hospital, Karachi This is a very vast subject and involves multiple steps as well as multiple personnel and severe logistical problems. There have been multiple reports and papers out on handling mass casualties and specially bomb blast injuries from both the developed countries and the developing countries. All these reports seem to have one thing in common that no country, city, county or even a small village can be prepared for a major calamity (natural) or disaster (manmade). It is a common feature that the first injured to arrive at the nearest medical facility whether it is a trauma center or not are persons with minor injuries as cuts and bruises and they seem to clog up the emergency room and hence leads to delay in treating persons who are seriously injured and who can be salvaged. The other thing which is very common is persons who cannot be savaged or are already dead are transported first to the trauma center and this further adds to the agony of medical personnel who cannot attend the patients who can be saved. All these issues need to be addressed and there should be a starting point. What should be the starting point is very important. • Teaching and training of medical personnel as to how to do triage • Who should do triage • Which patients to be shifted first • Where to take the injured ( coordination between hospitals and ambulance services) I will be elaborating mainly on the last two points in the presentation with lessons which we have learnt in recent past in our own city.

OPTIMISING POLYTRAUMA PATIENTS AT THE SITE OF BOMB BLAST
DR. M. YOUNIS KHATRI The Bomb Blast incidents are increasing day by day. The explosive devices cause injuries through several mechanisms, like penetrating fragment wounds, blunt injuries and hollow viscera injuries due to blast pressure. When blast overpressure wave reaches the person causes direct tissue damage by Spallation, Implosion and shearing forces, mainly involve lungs, gut and ear. The patients are categorized and labeled as, immediate care (red), delayed care (yellow) and unsalvageable (black). All patients with life threatening injuries should be identified and provided appropriate trauma care. Repeated reassessment is required to prevent late diagnosis of potentially life and limb threatening injuries. Explosion forces can give rise to pulmonary haemorrhage, contusions, direct barotraumas and arterial air embolism. Maintain and protect airway, place the affected lung in the dependent position, needle decompression of the chest for tension pneumothorax. Two large bore intravenous lines are passed for fluid therapy in haemodynamic unstable patients. Abdominal solid organs and viscera can give rise to intestinal perforation or ischaemia as the result of blast pressure. Head injury, cervical injury and spinal injury need special care during transport by applying cervical collar and placing the patient on long back board. Limb injuries include amputation, fractures, crush injuries need immobilization by splint and cover the wound if any with sterile dressing. CONCLUSION: Maintain and protect the airway, protect the spine by collar or long backboard, two large bore I/V lines for fluid resuscitation, immobilize fractures and apply sterile dressing on open wound. Then shift the right patient to the right hospital at the right time. KEY WORDS: Polytrauma patients, bomb blast injuries, pre-hospital triage.

ROLE OF GRAY SCAL AND DOPPLER ULTRA-SOUND IN THE DIAGNOSIS OF PAINLESS SCROTAL MASSES IN PATIENTS PRESENTING AT CIVIL HOSPITAL KARACHI
1DR ZAHOOR AHMED KHATRI & 2DR SABA SOHAIL 1FCPS-II Trainee, 2Associate Professor Department of Radiology Dow University of Health and Sciences Civil Hospital, Karachi {E-mail: dr.zahoorkhatri@gmail.com} INTRODUCTION: Patients presenting with scrotal or testicular mass require diagnostic imaging which provide information which may not be available from clinical examination alone .most frequent conditioned causing painless scrotal masses include hydrocele, spermatocele, cyst, malignant and benign tumours. Testicular and scrotum related disorders account for 3.7% of surgical admission in a tertiary care hospital. OBJECTIVE: The objective of this study is to determine the role of gray scale and Doppler Ultrasound in the diagnosis of painless scrotal masses by taking histopathology as gold standard. STUDY DESIGN: Cross sectional study. SETTING: Department of Radiology, DUHS/Civil Hospital, Karachi. DURATION: from June 2006 to till June2007 PATIENTS AND METHODS: A total of 70 patients with painless scrotal mass were included in the study. Sonographic and clinical examinations have been preformed in both supine and erect position in a room affording privacy. All subjects have been examined with a NEMO 17 Color Doppler scanner equipped with 11 MHz biconvex and linear transducers patients were scanned in supine position. The scrotal contents were elevated by folded towel positioned between the patients’ legs. Penis was positioned over the supra pubic region draped with

second towel. Some patients were scanned in erect posture as per need. Doppler ultrasound was done to assess and document the blood flow, spectrum, and velocity of flow and indices in the epididymis, as well as in the lesion. RESULTS: The average age of the patients was 38.51 ± 9.4 years (95%CI: 37.16 to 40.24). The most common scrotal mass was hydrocele 24(34.29%) patients followed by varicocele 13(18.57%), testicular tumors 12(17.14%), spermatocele 11(15.71%) and epididymal cyst was observed in 10(14.29%) patients. Out of 12 testicular tumors, 05 cases of seminoma (41.7%) were seen; embryonal cell carcinomas were detected in 02(16.7%) patients. Two cases were epidermoid cyst (16.7%), 01(8.3%) case teratoma, 01(8.3%) choriocarcinoma with metastasis and 01 case of testicular lymphoma (8.3%). Sensitivity and positive predictive value of the gray scale and Doppler Ultrasound were 66.7% and 100%. CONCLUSION: Gray scale ultrasound in combination with colour Doppler ultra sound is continuing to be a fast, effective and noninasive technique ofÊchoice in the patients present withÊpainless scrotal masses. KEY WORDS: Ultrasound, painless scrotal mass, testicular tumor

DIAGNOSIS AND STAGING OF OVARIAN CANCER; COMPARATIVE S T U D Y B E T W E E N U LT R A S O U N D A N D C O M P U T E D TOMOGRAPHY, CORRELATED WITH SURGERY
DR. SAIRA NAZ Consultant Radiologist Department of Radiology and Imaging Liaquat National Hospital, Karachi INTRODUCTION: Ovarian cancer is the second most common gynecological malignancy. Ovarian cancer causes more deaths than any other cancer of the female reproductive system. The incidence & mortality rate of ovarian cancer increases with age & peak at the age of 80 years. Other risk factor include early onset of menses, nulliparity, family history of ovarian cancer, breast cancer & late menopause. METHODS: The study was completed during 16 months, done from 02,10,2002 to 12,02,2004 and carried out for 50 patients Women over 18 yrs of age, referred to Ziauddin Hospital were admitted to the study if they were suspected to have ovarian cancer on the basis of abnormal results of a pelvic examination and/or a preliminary pelvic US study. Ultrasound was done with real time 3.5 MHZ convex scanner of Tosbee machine. CT scan was done on Toshiba-CT system. Surgery was done in all 50 cases. Staging was done according to Modified F.I.G.O. RESULTS: The results of analysis of sensitivity and specificity pair suggest that: • Ultrasound was more sensitive (100%) but less specific (27%) than CT scan (50%, 87%respectively), for the detection of stage I. • CT was more sensitive (75%) and almost equally specific (80%) than ultrasound (10%, 95%respectively), for the detection of stage II. • CT was more sensitive (54%) and almost equally specific (97%) than ultrasound (27%, 100%respectively), for the detection of stage III. • CT was more sensitive (100%) and almost equally specific (95%) than ultrasound (75%, 100%respectively), for the detection of stage IV. CONCLUSION: Our study shows that CT is consistently better then US in ovarian cancer staging, especially for stage II, III, and IV. KEY WORDS: Ovarian carcinoma, Ultrasound, Computed tomography, Surgical staging.

COMPARISON OF CT AND SONOGRAPHY IN THE DIAGNOSIS OF ACUTE APPENDICITIS
DR. RUBINA ASHRAF, DR. MUHAMMAD AYUB MANSOOR Liaquat National Hospital, Karachi OBJECTIVE: Our objective was to compare the accuracy of CT and sonography for the diagnosis of acute appendicitis in patients with suspected acute appendicitis at our institute. SUBJECTS AND METHODS: In this prospective study, 22 consecutive patients with clinical signs and symptoms of acute appendicitis were examined with sonography and CT. The primary sonographic criterion for diagnosing acute appendicitis was an incompressible appendix with a transverse outer diameter of 6 mm or larger with incompressible periappendicular inflamed fat with or without an appendicolith. The primary CT criterion for diagnosing acute appendicitis was the identification of an appendix with a transverse outer diameter of 6 mm or larger with associated periappendiceal inflammatory changes. The results, independently reported, were correlated with surgical findings. RESULTS: Eighteen patients had acute appendicitis at surgery, and 4 patients did not. The sensitivity of CT and sonography was 87.5% and 80% respectively; the specificity was 66.6% and 75%; the positive predictive value was 100% and 57.1%; and the negative predictive value was 66.6% and 50%. CONCLUSION: CT and sonography performed for the diagnosis of acute appendicitis have comparable sensitivity and specificity.

ROLE OF ABDOMINAL ULTRASOUND INTRAUMA PATIENTS
VAQAR BARI & S M FAISALMOSHARRAF Department of Radiology Aga Khan University Hospital Karachi OBJECTIVE: To evaluate sensitivity, specificity, feasibility and accuracy of ultrasound in detecting hemoperitoneum in blunt trauma patients.

FREQUENCY OF PENILE ARTERIAL INSUFFICIENCY AND VENOUS LEAKAGE IN PATIENTS HAVING ERECTILE DYSFUNCTION BY COLOR DOPPLER SONOGRAPHY
ADNAN HASHMI, JAVED MEHBOOB, ABID HAMEED Karachi Institute of Radiotherapy and Nuclear Medicine, Karachi {E-mail: dradnanhashmi@hotmail.com} OBJECTIVE: To determine the frequency of penile arterial insufficiency and venous leakage in patients having erectile dysfunction by color Doppler sonography. MATERIAL METHODS: The study was conducted at the radiology department of KIRAN hospital , Karachi. A total of 30 patients between ages of 20 to 67 years presenting with history of erectile dysfunction were evaluated with duplex color Doppler ultrasound. Spectrum was obtained from each patient at 5 mins interval for 30 mins following intracavernosal injection of 50 mg papaverine Hcl. Physical clinical examination and endocrine profile was also done which was within normal limits. RESULTS: the mean age of patients were 37.3±12 yrs (20-67). Following 50 mg papaverine Hcl , 23 of 30 patients (76%) had normal, while 7 out of 30 patients (24%) had abnormal PSV and EDV. 2 out of 30 patients ( 6 % )had PSV of less than 35 cm/s (Normal= >35cm/s) indicating arterial insufficiency. 5 out of 30 ( 25% )patients had EDV more than 5 cms/s (Normal = < 5 cms/s) indicating venous leakage. CONCLUSTION: This study concludes that we detect by Doppler ultrasound arterial insufficiency (6%) and venous leakage (25%) as a cause of erectile dysfunction. Hence Doppler ultrasound can be used as baseline investigation in these patients and can reliably rule out the vasculogenic cause of erectile dysfunction from physical, psychological and pharmacological etiologies.

DESIGN: A prospective and descriptive study. PLACE AND DURATION OF STUDY: Radiology Department, Aga Khan University Hospital Karachi from Nov 2006to 30thFeb 2007. SUBJECTS AND METHODS: All victims of blunt abdominal trauma presenting to emergency room of Aga Khan University Hospital over the age of fifteen years were included in the study. Patients were excluded if a bedside ultrasound examination was not completed or expired in the early period before CT or other imaging examinations could be done or if injuries were not confirmed by laparotomy or autopsy. RESULTS: Out of the 148 adult patients, 115 were males and 33 females. Presenting age ranged from 16 to 74 years. There were 15 true positive and 131 true negative results. One case was false positive and 1 false negative. Sensitivity was 93.75%, specificity 99.24%, accuracy 98.64%, positive predictive value 93.75% and negative predictive value99.29%. CONCLUSION: Ultrasound is safe, cost effective, sensitive, specific and accurate in detecting hemoperitoneum in patients with blunt abdominal trauma.

FIRST STUDY OF UTERINE ARTERY DOPPLER SCREENING IN THE SECOND TRIMESTER FOR PREDICTION OF ADVERSE PREGNANCY OUTCOME IN HIGH-RISK PAKISTANI WOMEN
NURUDDIN MOHAMMED, RAHAT QURESHI, ROZINA NURUDDIN*, LUMAAN SHIEKH, AISHA WALI Department of Obstetrics and Gynaecology, Aga Khan University, Karachi Division of Epidemiology and Biostatistics, Department of Community Health Sciences, Aga Khan University, Karachi INTRODUCTION: The aim of this prospective study was to assess the role of uterine artery Doppler (UtAD) studies in high-risk pregnancies in the second

trimester for prediction of adverse pregnancy outcomes such as intra-uterinegrowth-restriction (IUGR), gestational hypertension (GH), pre-eclampsia (PE), stillbirth and placental-abruption. METHODS: UtAD studies were performed between 16-23 weeks of gestation in singleton high-risk pregnancies. Each woman had only one UtAD ultrasound. Pregnancies with diagnosed fetal abnormalities were excluded. Data from 219 high-risk women were evaluated. RESULTS: Mean maternal age was 29 years (SD 5.1). Mean gestational age for UtAD and for delivery was 20 weeks (SD 2.43) and 37 weeks (SD 2.85), respectively. Average birth-weight was 2.63kg (SD 0.72). The estimated prevalence of adverse pregnancy outcome was 45%. For all outcomes, the test positive and negative predictive values were 59% (95%CI: 51%, 66%) and 96% (95%CI: 86%, 99%) respectively and the test sensitivity and specificity were 98% (95%CI: 92%, 99%) and 44% (95%CI: 35%, 53%), respectively. Sixty-nine women (32%) had IUGR, 15 (7%) and 28 (13%) developed GH and PE respectively. There were two (1%) placental abruptions and stillbirths, respectively. The conventional positive and negative likelihood ratios were 1.75 (95%CI: 1.49, 2.06) and 0.05 (95%CI: 0.01, 0.18). CONCLUSION: Uterine artery Doppler studies is a useful tool in the second trimester for prediction of adverse outcomes in at-risk pregnancies with high negative predictive values.

The prevalence is growing. Along with the disease the frequency with which its complications are encountered in clinical practice are also increasing. The common complications being portal hypertension and malignant transformation with development of hepato-cellular carcinoma. Radiology plays a central role in the management of chronic liver disease and its complications. Tripahsic computed tomography is now the standard of care in the diagnosis of hepato-cellular carcinoma with tissue diagnosis with biopsy only required in a small number of equivocal cases. Similarly Radiorfrequency abalation (RFA)and Transcatheter Chemo-embolisation, Radiofrequency ablation (TACE)give survival benefits similar to hepatic resection . The presentation will highlight the role of radiology in the diagnosis of conditions such a hepatocellular carcinoma, portal hypertension and ascities. The role of ultrasound, multiphase CT and MR in the diagnostic algorithms, and the role of Transcatheter Chemo-embolisation, Radiofrequency ablation, alcohol injection, trans jugular intrahepahtic porto systemic shunting and other interventional radiology techniques in the treatment of the complication of CLD will be reviewed.

SECOND SESSION
2.2 Magnetic Resonance evaluation of the White Matter. Zafar Sajjad Visiting Professor Jinnah Post Graduate Medical Centre. Karachi. Although Magnetic Resonance Imaging has revolutionised the entire field of neuroimaging, one of its most significant impacts has been in the area of imaging of the abnormalities of the white matter of the brain and the spinal cord. With the MR imaging it was possible for the first time to differentiate between the various pathological processes in the living brain that lead to disease states. for example no other modality allows the rapid and accurate differentiation of oedema, demylination and infarction (all of these would appear as low attenuation areas on CT scanning) as does MRI. Using this we are now able to detect and characterise disease of the white matter very early in the course of the illness. In fact the sensitivity of MRI for white matter lesions is so high that we sometimes detect abnormalities, the clinical significance of which are doubtful. From this dilemma was born the entity called Unidentified Bright Object or UBOs. Although it is convenient to label lesions as UBO early plaques of Multiple Sclerosis also appear similar and the diagnostic dilemma is not easy to resolve. This review will not only try to answer the fundamental question of MS vs UBOs but also highlight the features of the more common white matter disorders such as ischaemic "demylination", Acute Disseminated Encephalo Mylitis, Progressive Multifocal Leucoencephalopathy, and touch upon the metabolic and inherited white matter disorders.

MRI IMAGING IN THE EVALUATION OF MEDICALLY INTRACTABLE EPILEPSY
MAHREEN RASOOL, MUHAMMAD SALMAN, NADIRA ABID, SAIMA IMRAN, TARIQ MAHMOOD. Department of Radiology Jinnah Postgraduate Medical Centre, Karachi OBTECTIVE: To determine the efficacy of dedicated epilepsy protocol MRI in the evaluation of medically refractory epilepsy. INTRODUCTION: The imaging of epilepsy has changed during the last 15 yrs. Prior imaging with Computed axial Tomography infrequently revealed the pathological substrate for epilepsy. Routine MRI will exclude ominous structural abnormalities that require intervention such as gliomas and arteriovenous malformations, subtle structural substrates such as hippocampal sclerosis and malformations of cortical development (MCDs) are usually missed. The advent of the high-resolution magnetic resonance imaging with a dedicated epilepsy protocol has significantly increased the frequency that a pathologic substrate for epilepsy is identified. This has had a dramatic clinical impact on the evaluation and management of epilepsy. PURPOSE OF STUDY: Is to establish the importance of adding a dedicated epilepsy protocol MRI in the evaluation of partial onset complex seizure also known as temporal lobe epilepsy. METERIAL AND METHODS: A descriptive cross-sectional study, conducted at department of radiology, Jinnah Postgraduate medical centre, Karachi over a period of six months ( July to Dec 09). Age ranged 20-50 yrs, patients with the clinically proven partial complex seizures and long duration epilepsy with suspected temporal lobe focus underwent MRI examination. MRI was performed using conventional T1 and T2 weighted axial and FLAIR coronal images with 5 mm slice thickness and gap of 1 mm, while dedicated epilepsy protocol includes 3mm coronal oblique images with a gap of 0.3mm through hippocampus. Gadolinium was used when tumor or a vascular malformation was suspected on routine imaging. MRI examination were evaluated for Mesial temporal sclerosis using variables of change in signal intensity, atrophy or sclerosis of Mesial temporal lobe and for other temporal lobe abnormalities including dysplasis, AVMs and Tumor. RESULTS: Out of 40 patients included in study, 27 patients had Mesial Temporal sclerosis; out of them 23 patients presented with unilateral involvement. Bilateral involvement found in 4 patients and 1 patient out of these 4 also had associated periventricular leukomalacia. Dual pathology found in 2 patients having arteriovenous malformation along with mesial temporal sclerosis. 3 out of 40 patients having enlarged temporal lobe, due to cortical dysplasia in 2 patients while 1 had low grade tumor. No abnormality found in remaining 8 out of 40 patients. CONCLUSION: Adding a high resolution dedicated epilepsy protocol MRI has revolutionized the evaluation of Temporal lobe epilepsy.

ABSTRACTS FOR FREE PAPERS
FIRST SESSION 1.1 EVALUATION OF CONGENITAL HEART DISEASE BY MULTIDETECTOR CT DR. RUKHSANA TARIQ, DR. SHAHZAD BABAR & DR. RASHID AHMED Advanced Radiology Clinic (Pvt.) Ltd. Behind Taj Medical Complex, Off. M. A. Jinnah Road, Karachi. {E-mail: arcra@cyber.net.pk} INTRODUCTION: Echocardiography is the diagnostic modality of choice in patients with CHD. The aim of the study was to establish the role of multi-detector CT complimentary to echocardiography in order to assess morphologic and functional information especially in pre and post surgical evaluation and detection of concurrent extra-cardiac anomalies. MATERIAL AND METHODS: Thirty patients with known CHD of different ages and both sexes were included in the study after a preliminary clinical examination by a pediatric cardiologist and echocardiographic examination. All MDCT studies were performed to resolve equivocal features on echocardiography and to answer specific questions raised by an inconclusive echocardiography and assessment of extra-cardiac abnormalities. The images were reviewed by two senior radiologists. RESULTS: All patients diagnosed with congenital heart disease on echocardiography with an inconclusive on equivocal features were successfully evaluated on MDCT. Generally complex and combination of anomalies were seen. Extra-cardiac anomalies were seen in 17 cases. Intra-cardiac communications were seen in 10 cases. Tetralogy of Fallot was noted in 6 cases. Right sided aortic arch and isomerism were seen in 1 case each. Abnormal vascular connections were observed in 5 cases. Anomalous coronary arteries were seen in 3 cases. Bilateral SVC was seen in 2 cases. 4 Post surgical cases

Role of Radiology in the Management of Chronic Liver Disease:
Dr. Tanveer Ul Haq Associate Professor, Aga Khan University Hospital Karachi. Chronic liver disease secondary to viral hepatitis is endemic in Southeast Asia.

included RSP shunts, aortic graft with mural thrombosis and pulmonary valve replacement. CONCLUSION: The study was able to present a wide variety of anatomic and pathologic examples of CHD pertinent to the cardiac surgeon for pre-surgical assessment and road mapping. MDCT has revolutionized the imaging spectrum and successfully met the challenge.

CONCLUSION: MR arthrogram shoulder is highly accurate in the detection of shoulder instability. KEY WORDS: MRI shoulder arthrogram, MR Arth, labrum, gleno-humeral ligaments, biceps tendon, rotator cuff.

1.2 CT GUIDED LUNG ABSCESS DRAINAGE
Dr MAHIRA YUNUS Associate Professor Department of Radiology Sindh Institute of Urology & Transplantation, Karachi OBJECTIVE: To determine the efficacy of CT- guided transthoracic catheter drainage of intrapulmonary abscess considering success rate versus complications. MATERIALS & METHODS: This prospective study was carried out at radiology department of Al-Noor Specialist Hospital, Makkah, Saudi Arabia, from 1.1.2003 to 31.12.2005 (about 2 years). 19 patients were selected for CT guided percutaneous drainage. Under CT guidance catheter placement was carried out using Seldinger technique. RESULTS: Nineteen patients with lung abscess were selected in this study for the percutaneous CT guided drainage. Out of these nineteen patients, in eight patients (42.105%) no complications occurred and lung abscess was completely resolved with no residual cavity. Five out of nineteen patients (26.31%) developed pneumothorax, which is the most common complication occurred during this study. These patients were kept under observation and followed-up by chest Xrays. Three of them (15.78%) had mild pneumothorax, which resolved and needed no further management, while two patients (10.52%) developed moderate pneumothorax and chest tube was inserted. Two out of nineteen patients (10.52%) developed mild hemoptysis and it was resolved within two hours, hence, no further management was required. Two patients (10.52%) had residual cavity left, surgery was performed in both cases and revealed congenital cystic adenomatoid malformation (CCAM) in both cases. Two patients out of nineteen patients (10.52%) developed bronchopleural fistula and were operated. No mortality occurred during or after procedure. CONCLUSION: CT allows optimal placement of catheter and hence enable safe and effective percutaneous evacuation of lung abscess. The morbidity and mortality of patients with percutaneous catheter drainage is lower than with surgical resection. Hence, CT guided drainage should be considered the first therapeutic choice in most patients of lung abscess who do not respond to medical therapy.

1.5 AWARENESS OF RADIATION PROTECTION IN CLINICAL AND NON-CLINICAL STAFF
SHAHEEN DHANANI, AFSHEEN MAHMOOD, AMIN RAJANI & FAREED JUMANI Department of Radiology The Aga Khan University Hospital, Karachi INTRODUCTION: Increasing concern has recently been expressed in the literature that the referring clinical and non-clinical staff knowledge of radiation doses incurred during radiological procedure is inadequate. Such information may be particularly relevant when the expansion of imaging technology is considered. To assess this, a survey was conducted of the awareness of radiation dose and risk among health professionals. OBJECTIVE: “To evaluate the level of awareness about radiation protection in clinical & non-clinical staff.” METHOD & MATERIAL: The authors develop two questionnaire level “A” & “B”. Level “A” is for radiation technologist & level “B” is for non-clinical staff of AKUH. The questionnaire of level “A” pertaining to radiation protection practices, procedures, dose limits & existing of national & international standards. The questionnaire of level “B” contained basic radiation protection awareness from nurses of different wards, clinical receptionist, porters etc. 50% radiation technologist & 50% non-clinical staff (1:1) evaluated prospectively. RESULTS: Survey for Non- Clinical Staff: A total no. 50 questionnaires were distributed in non-clinical area of radiology including radiological reception, ER, C1, B1. Out of which 86% questionnaires were returned with answers, 14 % of them refused. Numerical Representation: Location ER C1 B1 Radiology reception No. of Non- Clinical Staff 14 9 12 8

1.3 MAGNETIC RESONANCE ARTHROGRAM: A SCREENING TEST TO DIAGNOSE SHOULDER JOINT INSTABILITY
*MUNAZZA SALEEM BAIG, ZAFAR SAJJAD *Resident Department of Radiology Aga Khan University Hospital Karachi INTRODUCTION: Magnetic Resonance Imaging (MRI) has been used with inconsistent success to diagnose shoulder joint instability. As it has high softtissue contrast, therefore it allows better discrimination of fat, muscle, tendon, and cartilage. Magnetic Resonance Arthrography (MR Arth) of shoulder, involving intra articular contrast injection is the most accurate established imaging method for demonstrating abnormalities of the glenoid labrum and associated structures. It provides better anatomic detail than conventional MRI. MR Arthrography can avert unnecessary diagnostic arthroscopies thereby reducing the workload of an orthopedic surgeon and financial burden and anesthesia related complications amongst patients. Besides this, it can also help surgeons in preoperative planning by providing excellent anatomical and pathological details. MATERIALS AND METHODS: MR Arthrography shoulder and Arthroscopy findings in 40 patients referred to the Radiology department AGA Khan University hospital Karachi, by primary physicians with suspected shoulder instability between September 2008 and August 2009 were recorded. Arthroscopy was taken as gold standard. The data was collected on the proforma and analyzed on SPSS Version 10 assessing the sensitivity, specificity, the negative and positive predictive values and accuracy of MR Arthrpgraphy shoulder against the gold standard. RESULTS: MR Arthrography shoulder has a sensitivity of 94%, specificity of 100% positive predictive value of 100%, and negative predictive value of 60% and diagnostic accuracy of 95 % in assessing shoulder joint instabilities.

Survey for Clinical Staff: A total no. 50 questioners were distributed in Radiology AKUH including radiographers and senior radiographers. Out of which 92 % were returned with answer, 8 % of them refused. • 55% males were evaluated. • 45 % females were evaluated. • 13% were not interested to give their data. • 30% were senior radiographer. • 69% were radiographers & trainee radiographers. CONCLUSION: Our survey demonstrated that the awareness level of nonclinical staff is 60% which is satisfied but they should have more knowledge because they have little bit exposure during portable x-rays & departmental procedures. Awareness level of clinical staff is 67.3% which is not satisfied because they are continuously working in radiation area so they need more attention regarding to the awareness of radiation protection. We increase this level by arranging different sessions, quiz or by distributing pamphlet or handouts regarding to the hazards of radiation.

SECOND SESSION
2.1 TO DETERMINE THE SENSITIVITY OF DIFFUSION WEIGHTED MR IMAGING (DWI) IN DETECTION OF ENDOMETRIAL CARCINOMA (CASE CONTROL STUDY): ROLE OF ADC (APPARENT DIFFUSION COEFFICIENT) VALUES *IMRANA MASROOR, DR. MUHAMMAD ZEESHAN, DR SHAISTA AFZAL, DR. GULNAZ SHAFQAT, DR. NADEEM AHMED *Department of Radiology Aga Khan University Hospital, Karachi PURPOSE: To calculate the sensitivity of MRI utilizing diffusion weighted imaging (DWI) in detection of endometrial cancer and to investigate whether the ADC values of endometrial cancer differ from normal endometrium. INTRODUCTION: Endometrial carcinoma is currently the most common gynecologic malignancy all over the world.It is usually diagnosed in early stages because of postmenopausal vaginal spotting or bleeding.Its prognosis depends on, histologic sub type, grade, depth of myometrial invasion and involvement of lymph nodes.MRI has been used for proper surgical and therapeutic planning with relatively high accuracy. Diffusion Weighted ( DWI) MRI is a recently prevailing technique used to show tissue characteristics based on diffusion motion of water molecules. The utility of this technique has been established in CNS and is regarded as most sensitive tool for diagnosing acute cerebral ischemia.The

application of DWI has recently been applied to abdominal organs, and has depicted malignant tumors with high conspicuity.The measurement of Apparent Diffusion Co-efficient (ADC) values of tumor versus non tumor has shown great promise in differentiating them from each other. METHODS AND MATERIALS: A cross sectional study conducted at Radiology Department, Aga Khan University hospital, Karachi. Study period was from January 2007 to June 2009. A total of 30 patients and 30 controls were included that underwent MRI examination . The patients had surgical diagnosis of endometrial cancer, and the controls had normal endometrium after surgery.Controls underwent surgery for indications other than endometrial pathology. Data was analyzed using SPSS 16. The sensitivity of MRI for detection of endometrial carcinoma was calculated, and the ADC values of normal and abnormal endometrium were recorded. The statistical difference between ADC (Apparent Diffusion Coefficient) values was calculated by two-sided student ttest. P value of <0.05 was considered statistically significant with confidence interval of 90%. RESULTS: Out of 30 patients included in the study, 21 had hyperintense, 6 hypointense and 3 had isointense endometrium on T2 weighted imaging. On DWI, all lesions were depicted as increased signal with hypointense myometrium. The sensitivity for detection of DWI was 100%.The mean ADC value for abnormal endometrium was 622 and of normal endometrium was 1234( p value of >0.0001), at b-value of 1000nm/sec. CONCLUSION: In this series of highly selective patients MRI examination utilizing DWI is a very sensitive tool in detecting endometrial cancers. Determination of ADC value is helpful in differentiating normal from malignant endometrium.

OBJECTIVE: To determine the sensitivity of SWI in further characterization of brain lesions identified on conventional MR imaging. INTRODUCTION: SWI originally called BOLD venographic imaging emerged as a powerful clinical tool to visualize vascular structures, iron content, blood products as well as calcification. It can detect small amount of bleed which is even undetected on routine CT\MR examination. The clinical application of SWI has been described in vast neurological lesions like traumatic brain injury, coagulopathies, vascular malformation, neoplasms and even in neurodegenerative disorders providing valuable additional information in lesion delineation. MATERIALS AND METHODS: A descriptive cross sectional study carried at radiology department, Jinnah Post Graduate Medical Center Karachi over a period of 3 months (November 2009 till January 2010). We retrospectively reviewed MRI examination of 120 patients over a period of 3 months in whom signal abnormality was picked on conventional T1,T2 and FLAIR images with 5 mm slice thickness and gap of 1 mm. SWI was then performed in these patients with protocol of TR= Shortest, TE= 15 ms, flip angle=15degree and 120 slices through brain. SWI was evaluated for presence of blood products, vascularity and calcifications in these patients appearing as low signal. RESULTS: Out of 120 patients with signal abnormality detected on conventional MRI 90 (75%) were confidently characterized and 30(25%) were unclassified. Out of these 90patients diagnosis of 76 (84.4%) remained unchanged after SWI and in 14 (15.6%) patients diagnosis was changed. Out of 30 (25%) unclassified patients 8 (26.6%) remained unchanged while 22 (73.4%) were diagnosed confidently using SWI. CONCLUSION: SWI is a new MRI sequence that exploits the magnetic properties of tissues due to local inhomogenieties in the magnetic field and is extremely sensitive to even traces of hemorrhage with potential diagnostic and therapeutic implications in stroke patients as well as in other hemorrhagic conditions, brain neoplasms, phacomatoses like sturge weber disease and neurodegenerative diseases. SWI adds only a few minutes to the current protocol of brain MRI but its use significantly improve the patient care and management and therefore should be performed in patients with signal abnormality detected on conventional MRI.

2.2 FLEXION / EXTENSION CERVICAL SPINE VIEWS IN BLUNT CERVICAL TRAUMA
SADAF NASIR, MANZAR HUSSAIN, M. AYUB MANSOOR Liaquat National Hospital, Karachi INTRODUCTION: In the United States, 600,000 radiographic studies of the cervical spine are performed annually for the evaluation of spinal trauma. The use of flexion and extension radiographs in acute trauma, however, has infrequently been subjected to a critical evaluation and many questions need to be answered. The continued suggestion that flexion and extension views be obtained in cases of blunt trauma does not appear to be based on scientific evidence but may result from anecdotal case reports describing posttraumatic instability in patients with normal standard radiographic evaluations of the cervical spine. Few studies have compiled data with the purpose of directly evaluating the utility of the flexion and extension radiograph of the cervical spine in the setting of blunt trauma. The purpose of this study was to examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma. METHODOLOGY: All those patients who presented to the emergency department following trauma, regardless of the nature of trauma were included in the study. All these patients underwent cross table cervical spine x ray. The study was conducted after the approval of hospital’s ethics committee. Since it involved only collection of data it was conducted under waiver of consent. Patients of all ages and both sexes were included, however, those patient who showed neurological deficits or were less than 8 years of age, or had severe arthritic changes were excluded from the study. Adequacy of flexion extension views was checked prior to flexion extension views. All the demographic details including age, sex were recorded. The mechanism of injury, the associated injuries, the clinical findings relevant to cervical spine and x-rays findings in all the patients were recorded. The results were tabulated using SPSS version 16.0. RESULTS: 200 cases met the criteria for review. There were 50 female patients and 150 male patients. Of the males 130 were adults and 20 were children/adolescence .In females 45 were adults and 5 were children/adolescents. The mean age was 31.68 (11.95) years, with a range of 12-62 years. Trauma was secondary to motor vehicle crashes in 180 patients. Of these 140 were either traveling in cars or motorcycles and 40 were pedestrians. Falls in 20 patients. All the x-rays were judged adequate for diagnostic purpose otherwise they were repeated. The percentage of x-rays that were repeated was 90/200 because of either inadequate exposure or limited motion and 110/200 had adequate motion/exposure of the cervical spine. None of the patients had positive flexion extension views of cervical spine for instability. All patients were discharged without any neurological sequel. CONCLUSION: Loss of cervical spine lordosis alone should not be taken as an indication for performing flexion and extension views.

2.5 HEART: WHAT CAN BE SEEN ON NON CORONARY THORACIC MULTI DETECTOR COMPUTED TOMOGRAPHY SCAN?
ZAFAR JAMIL Senior Charge Radiographer Radiology Department The Aga Khan University Hospital Karachi INTRODUCTION • Until recently although always present it was difficult to assess the heart on thoracic CT due to marked motion artefact. With the increasing use of multidetector CT there is now sufficient temporal and spatial resolution to assess the anatomy of the heart and look for any evidence of cardiac pathology. This may be incidental but is often the source of symptoms and can explain other radiological findings. Occasionally there are significant prognostic implications. • Objective: MDCT systems with fast scanning capabilities can acquire images of the thorax with reduced cardiac motion artifacts, enabling improved evaluation of the heart and surrounding structures in the course of routine thoracic CT. This describes the principles of including an evaluation of the heart in the course of a chest CT examination in terms of both examination technique and image interpretation. In addition, both the normal appearances and some of the most common abnormal appearances of the cardiac structures will be described. • By using cases collected from our hospital on multi-detector CT machines, we present a structured approach to assess the heart on routine thoracic CT. MATERIALS & METHODS: • Study Duration: January 2008 to December 2008 • Study type: Retrospective study • Study site: CT Scan Suite Radiology Dept. AKUH • Study Population: All patients undergoing Thoracic CT. • Machine model: 64 slicer MDCT Toshiba Aquillion • No of patients: 100 • Source of data collection: Radiology information system (RIS) CONCLUSION • Whilst gated cardiac CT no doubt provides superior imaging of some cardiac disease compared to conventional CT, extensive information is obtainable on multi-slice imaging. • It is significant to develop a method for looking at the heart on thoracic CT

2.3 ADDITIVE VALUE OF SUSCEPTIBILITY WEIGHTED IMAGING (SWI) IN
NEURORADIOLOGY Shaista Shoukat, Nadira Abid, M.Salman, Saima Imran, Tariq Mahmood. Department of Radiology, JPMC Karachi.

MDCT ASSESSMENT OF ACETABULR FRACTURES: A COMPARISON OF CONVETIONAL MPR AND 3D IMAGES WITH MODIEFIED RECONSTRUCTION IMAGES
KAUSAR ILLAHI BUX , MUHAMMAD SALMAN, NADIRA ABID,SAIMA IMRAN, TARIQ MEHMOOD Department of Radiology. Jinnah post graduate medical center, Karachi Object: To establish a role of modified MPR images as a standard protocol for the evaluation of acetabular fracture. Study design: descriptive study. Place and duration: Radiology department, Jinnah post graduate medical center, from March to October 2009. Subjects and method: A prospective study carried out in 22 patients in whom acetabular fractures were demonstrated on initial radiographs underwent CT examination. Patient’s age ranged from 16 to 49 years with male to female ratio 18: 4. All studies were performed on Toshiba aquillion helical 16 slicer, with 2 mm slice thickness, tube voltage120kvp and tube current ranged from 150225mAs, FOV is 250-350mm. Scans were performed form L5 vertebra to lesser trochanter of femur with approximate scan time of 5 seconds. Beside conventional MPR, modified thick slab (3-5 mm) MPR images were acquired with oblique coronal & oblique sagittal views through anterior column, posterior column and both columns using window length of 350 and window width 2000 HU. Result: In all 22 patients elementary acetabular fractures were present, 12 out of 22 patients had anterior column fracture, out of them 4 had associated anterior wall fracture. 6 patients had both columns fracture, 2 patients had posterior column fracture, and 2 patients had isolated posterior wall fracture. Associated fractures also noted in 10 out of these 22 patients,1 patient with anterior column injury had associated iliac bone fracture and ipsilateral sacroiliac diastasis. Conclusion: Conventional MPR images can appropriately classify the acetabular fracture but, reformatted modified thick slab oblique images through anterior, posterior and both columns, provide better visualization and maximum information of acetabular fractures on single image. Fractures with less than 2mm diastasis which remain inconspicuous on 3D reformates, are more evident on these modified reformatted images.

RESULTS: pQw were positive in 55/306 (18%) patients and 40/55 (73%) had fixed perfusion defects while 15/55 (27%) had no fixed defect on MPI. In 47 patients fixed defects without pQw were seen. Overall sensitivity, specificity, negative and positive predictive values (NPV and PPV) of pQw for MI were 46%, 93%, 81% and 73% respectively. pQw in anterior leads had highest sensitivity than others regional leads. In patients with true positive pQw, mean LV ejection fraction (%EF), mean end diastolic (EDV) and mean end systolic (ESV) volumes were 36 % (±11.87), 170 ml (±70.28) and 114.38 ml (±67.40) respectively. More severe LV dysfunction was seen with true positive pQw in anterior ± inferior and lateral leads. CONCLUSION: pQw has an overall high specificity, low sensitivity but positive anterior leads have highest sensitivity. pQw has negative impact on LV function and more pronounced when present in anterior leads.

PREVALENCE OF POSITIVE GATED MYOCARDIAL SPECT IN DIABETIC AND NON-DIABETIC WOMEN AND IMPACT OF OTHER RISK FACTORS; KIHD PERSPECTIVE MASEEH UZ ZAMAN1,2,3; NOSHEEN FATIMA1,2; ABDUS SAMAD1; S ZAHID RASHEED1; M ISHAQ1; JAVERIA1; KAWISH REHMAN1,2; ASIF WALI1. 1Karachi Institute of Heart Diseases (KIHD), Karachi 2Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN) 3Dept. of Radiology, The Aga Khan University Hospital, Karachi OBJECTIVE: The objective of the present study was to assess the prevalence of coronary artery disease (CAD) among diabetic (DM) and non-diabetic (NDM) women using Gated SPECT (GSPECT) and to study the impact of other risk factors like hypertension (HTN), dyslipidemia, family history (F/H) and menopause. SUBJECTS AND METHODS: This is a prospective cross-sectional study on a consecutive sample of 287 women referred to Nuclear Cardiology Department of Karachi Institute of Heart Diseases (KIHD) for GSPECT for evaluation of known or suspected CAD (from January 2009 till June 2009). Women with a history of DM diagnosed less than 5 years were excluded. Same day (reststress) G SPECT study was conducted and fixed or reversible perfusion defects were considered positive GSPECT for CAD. RESULTS: GSPECT was positive for CAD in 41/115 (36%, p 0.002) diabetic women and 37/172 (21%, p 0.005) non-diabetic cohort. In diabetic cohort, GSPECT was positive in 5/9 (56%, p 0.013) women with diabetes only, 17/35 (48%, p 0.02) DM with HTN, 12/15 (80%, p value 0.02) DM with dyslipidemia and 11/43 (26%, p 0.001) DM with =2 risk factors. GSPECT was normal in all 3 diabetic women with positive family history for CAD. In non-diabetic cohort, GSPECT was positive in 9/32 (28%, p value 0.739) women with no risk factor, 15/58 (26%, p 0.866) HTN only, 2/5 (40%, p value 0.655) only dyslipidemic women, 1/12 (8%, p 0.004) with family history only and 4/23 (17%, p value 0.166) non-diabetic with =2 risk factors. Interestingly, 35/93 post-menopausal diabetic (38%, p value 0.017) had positive GSPECT while 33/123 non-diabetic postmenopausal women (27%, p 0.03) had positive perfusion scans. GSPECT was positive in 6/26 (23%, p 0.006) and 4/49 (8%, p 0.05) in diabetic and non-diabetic pre-menopausal women. CONCLUSION: The prevalence of CAD in our diabetic women is as high as internationally reported and diabetes is a strong risk factor for CAD. Dyslipidemia with diabetes is a major contributor to CAD than HTN and F/H. Diabetes erases the protective effect of estrogen in premenopausal diabetic women.

RECENT DEVELOPMENTS AND FUTURE PROSPECTS OF SPECT MYOCARDIAL PERFUSION IMAGING
DR. MASEEH UZ ZAMAN Department of Nuclear Medicine KIRAN & Department of Radiology Aga Khan University Hospital, Karachi Myocardial perfusion SPECT imaging is the most commonly used functional imaging for assessment of coronary artery disease. High diagnostic accuracy and incremental prognostic value are the major benefits while suboptimal spatial resolution and significant radiation exposure are the main limitations. Its ability to detect hemodynamic significance of lesions seen on multi-detector CT angiogram (MDCTA) has paved the path for a successful marriage between anatomical and functional imaging modalities in the form of hybrid SPECT/MDCTA system. In recent years there have been enormous efforts by industry and academia to develop new SPECT imaging systems with better sensitivity, resolution, compact design and new reconstruction algorithms with ability to improve image quality and resolution. Furthermore, expected arrival of Tc-99m labeled deoxyglucose in next few years would further strengthen the role of SPECT in imaging hibernating myocardium. In view of these developments it seems that SPECT would enjoy its pivotal role in spite of major threat to be replaced by fluorine-18 labeled PET perfusion and glucose metabolism imaging agents.

ROLE OF TC-99M MAG3 SCINTIGRAPHY IN MANAGEMENT OF NON FUNCTIONING KIDNEY ON INTRAVENOUS UROGRAPHY
DR. NAUREEN NIZAR1, & DR. AKHTAR AHMED 1,2 1Sindh Institute of Urology and Transplantation (SIUT) 2Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN) INTRODUCTION: Tc-99m MAG3 renal scan can quantitate absolute and differential renal function. Even 5 to 10 per cent of the renal function can be detected, while IVP reports a nonfunctioning kidney if the function falls by 60 per cent or more. This information helps urologist to plan nephrectomy or more conservative surgery. In identifying the urinary pathway obstruction, renal scintigraphy is superior to the conventional IVP, particularly in units with impaired renal function. MATERIALS AND METHODS: Sixty three patients of non-functioning kidney on excretory urography were studied by Tc-99m MAG3 renal scan with age range 08-75 years (mean age of 34years). 42 patients (66.6%) were male and 21 patients (33.3%) were female with 2:1 ratio. Diuretic dynamic renal scintigraphy (flow, function, delayed imaging) was performed after intravenous injections of 2-5mCi (74 - 185 MBq) 99mTc-MAG3 and 40 mg furosemide (at zero time, or F0). RESULTS: 23 (36.6%) patients showed no renal function and 18 (28.3%) patients showed poor renal function. Where as 22 (35 percent) of these patients showed significant renal function (split more than 15 percent) and thus could be candidate for renal salvage by relevant surgical procedures.

PREDICTIVE VALUE OF PATHOLOGICAL Q WAVES FOR FIXED PERFUSION DEFECT AND ITS IMPACT ON LV FUNCTION ESTIMATED BY GATED SPECT NOSHEEN FATIMA1,2; MASEEH UZ ZAMAN1,2,3; ABDUS SAMAD1; M ISHAQ1; S ZAHID RASHEED1; JAVERIA1; KAWISH REHMAN1,2; ASIF WALI1 1Karachi Institute of Heart Diseases (KIHD), Karachi 2Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN) 3Dept. of Radiology, The Aga Khan University Hospital, Karachi BACKGROUND: Sensitivity of pathological Q waves (pQw) has been questioned by perfusion and metabolism imaging. Present study was conducted to find its sensitivity and impact on LV function. SUBJECT AND METHODS: This prospective study included 306 consecutive cases (187 male; mean age 55.07 years) referred for same day (rest- stress) gated SPECT study (MPI).

CONCLUSION: Tc-99m MAG3 renal scan is mandatory before declaring a kidney totally non-functional. ROLE OF SPLIT DOSE BONE SCANNING FOR THE ASSESSMENT OF SKELETAL METASTASIS IN PATIENTS WITH MALIGNANCY
KASHIF NIYAZ, MASEEH UZ ZAMAN, AKHTAR AHMED, ABID HAMEED Karachi institute of radiotherapy and nuclear medicine (KIRAN), Off University Road, Near Safoora Chowk, Scheme-33, Karachi, {E-mail: } OBJECTIVE: The objective of this study was to find out the effect of split dose bone scanning on the pattern of uptake of 99mTc MDP in patients with proven neoplasm and to differentiate between benign skeletal processes and skeletal metastases. MATERIAL AND METHOD: The study has been conducted in patients attending the OPD of KIRAN Hospital, in the period of 6 months. A total of 50 histopathologically proven cases of malignancy were included, (Mean age=50.32±15; age ranges=20-80), F=30(60%); M=20(40%). All patients underwent 2 bone scans (at 4 hours and 24 hours) using split dose technique in which 550 MBq of 99mTc MDP injection was given after first scan. The images were looked for lesions, which were graded 1 to 5 accordingly on visual analysis. Three computerized regions of interest (ROIs) were drawn over lesion (ROI 1), normal bone (ROI 2) and soft tissue (ROI 3). The number of lesions, lesion to background ratios and lesion to soft tissue ratios of both 4 hours and 24 hours delayed images were calculated RESULTS: There was significant difference observed at 4 hours and 24 hours delayed bone scans for lesion to normal bone ratio and lesion to soft tissue ratio of grade 5, 4 and 3 lesions, while no significant difference was observed for grade 2 lesions. Same numbers of lesion were found both at 4 and 24 hours bone scans and no difference was observed in terms of numbers of lesion CONCLUSION: The data suggest that Split dose bone scan results in significantly increased values of lesion to normal bone ratio and lesion to soft tissue ratio in all metastatic lesions at 24 hours delayed imaging as compared to 4 hours bone scan and it is a valuable technique for differentiating benign skeletal processes from malignant lesions in patients with known malignancy.

UTILITY OF COMBINED TC-99M MIBI AND BONE SCAN IN SOLITARY MUSCULO-SKELETAL PATHOLOGY
ZAFAR NASIR*, MUHAMMAD EJAZ KHAN, SHAHID KAMAL, HASSAN RAZA, BASHIR AHMED, MINHAJ MAQBOOL, NAJAMUDDIN, SUMAIRA MUSHTAQ, RAHILA MEHMOOD, RUKHSANA MEMON, MUHAMMAD IQBAL, RAFIA TOOR Atomic Energy Medical Centre Jinnah Postgraduate Medical Centre, Karachi OBJECTIVE: The aim of this study was to assess the utility of combined 99mTcMIBI scintigraphy and bone scan in patients with clinical and radiologic features of solitary musculo-skeletal pathology. MATERIALS AND METHODS: The scintigraphic findings for 50 patients were compared with the surgical and histologic findings. Each patient underwent threephase bone scanning with 99mTc-methylene diphosphonate (MDP) and static MIBI scintigraphy. The MIBI scans were evaluated by visual and quantitative analysis. The count ratio of the lesion to the background (L/N) was calculated from the region of interest drawn on the MIBI scan. Ratio > 1.5 was considered positive test and < 1.5 as negative. The Chi square test was used to determine the statistical significance. RESULT: In 29 patients the test was positive and 21 patients had negative test. 31 patients came out malignant (osteosarcoma, ewings sarcoma, PNET, chondrosarcoma, soft tissue sarcomas) and 19 benign (giant cell tumor, aneurismal bone cyst, osteoid osteoma, fibrous cortical defect, simple bone cyst, fibrous dysplasia). Although increased MDP uptake was not specific for bone malignancy, a significant difference was found between benign tumors (L/N = 1.24 ± 0.45) and malignant tumors (L/N = 3.3 ± 2.3) on MIBI scans. Sensitiviy of combined MIBI and Tc-99m MDP bone scan for detecting benign vs malignant disease was 83% and specificity 84% with is statistically significant (p value <0.01). CONCLUSION: Although not capable of replacing tissue biopsy as a definitive diagnostic modality for musculoskeletal neoplasms, MIBI scintigraphy does appear to have a role in better preoperative assessment and in distinguishing between benign and malignant pathologies.

DETECTION OF CORONARY ARTERY DISEASE IN HYPERTENSIVE PATIENTS BY EXERCISE STRESS MYOCARDIAL PERFUSION IMAGING USING TC-99M MIBI
DR. MUHAMMAD OBAID ARIF Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN) Off University Road, Near Safoora Chowk, Scheme-33, Karachi, {E-mail: drcumengineer@hotmail.com} BACKGROUND: Hypertension and coronary artery disease (CAD) are mutually associated with one another and are a major cause of morbidity and mortality in the present day life. The presence of hypertension may cloud the diagnosis of CAD. Myocardial perfusion scanning can be used for non invasive detection of coronary artery disease in hypertensive patients. The aim of our study was to detect coronary artery disease in hypertensive patients who did not have a previous history of MI. The study methodology included exercise stress myocardial perfusion scan. METHODS: A total of 150 patients (72 males and 78 females with mean age 53.9 ± 8 years), referred by the physicians to the KIRAN hospital for the detection of CAD by exercise stress MPS, were enrolled into the study. Out of these 150 patients, 50 patients, who were normotensive, were registered as a control group (group-A). The remaining 100 hypertensive patients were divided into two groups; Group-B comprising of patients with hypertension as a solo risk factor for CAD and Group-C in which patients were having at least one additional coronary risk factor along with hypertension. Patients with positive scans for coronary artery disease were followed up at the interval of 3 months along with their angiography report and patients with negative scans were followed up for any cardiac event that occurred within 3 months of myocardial perfusion scan. RESULTS: Out of 40 scan positive patients 38 had their angiography positive and two scans were found to be false positive. Insignificant differences found between groups A & B (odds ratio 1.9, p = 0.202). Significant difference was observed between groups A & C (odds ratio 3.76, p = 0.006). Normalcy rate was found out to be 86%. CONCLUSION: Exercise stress Tc99m MIBI scan is a reliable method for detection of coronary artery disease in hypertensive patients. CAD is more common in hypertensive patients associated with at least one coronary risk factor than their matched normotensive patients. In patients with hypertension as a solo risk factor the prevalence of exercise MPS abnormalities were similar to control (normotensive)

ATTENUATION CORRECTION IN MYOCARDIAL PERFUSION SPECT IMAGING
BASHIR AHMED, EJAZ KHAN, SHAHID KAMAL, ZAFAR NASIR, BASIT IQBAL, HASSAN RAZA, SHAHEEN ZAREEN, NAJAM UDDDIN, RUKHSANA MEMON,SUMAIRAMUSHTAQ, RAHILA MEHMOOD, MINHAJ MAQBOOL Atomic Energy Medical Centre, Karachi INTRODUCTION: Attenuation of photons is one of the most important factors which degrade the quality of and destroys the quantitative accuracy in images obtained in nuclear medicine scans especially in cardiac imaging. The specificity of cardiac single photon emission computed tomography perfusion imaging is significantly affected by internal photon absorption commonly referred to as anterior wall breast and inferior wall diaphragm attenuation artifacts. AIMS AND OBJECTIVES: The goal of this research project is to assess the accuracy of attenuation correction in myocardial perfusion imaging. MATERIALS AND METHODS: 60 patients underwent a single day 99mTC MIBI protocol using Infinia Hawkeye gamma camera and ECG gated acquisition. The reader interpreted gated attenuation-corrected and non-attenuation-corrected rest/stress images. Wall motion abnormalities were assessed. RESULTS: Diagnosis of fixed perfusion defects in 22 cases was changed after interpretation of AC images and these perfusion defects were found to be attenuation artifacts corrected with attenuation correction soft ware. In all of these cases there was no wall motion abnormality on gated study. Out of these 22 artifacts, 14 were due to diaphragmatic attenuation and 8 due to breast attenuation. CONCLUSIONS: Attenuation correction in addition to ECG gating with SPECT myocardial perfusion images improves the image quality, interpretive certainty, and diagnostic accuracy.

LEFT VENTRICULAR EJECTION FRACTION DERIVED BY ECG GATED SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY VERSUS CORONARY ANGIOGRAPHY DETERMINATION IN SUSPECTED OR KNOWN CORONARY ARTERY DISEASE PATIENTS
SAJID SATTAR Department of Nuclear Medicine ÊDr. Ziauddin Medical University Hospital, Karachi {E-mail:sajsky@yahoo.com / drsajidsattar@gmail.com} Evaluation of the left ventricular function is an important parameter in the assessment of cardiac mortality and morbidity. Quantifying the degree and extent

of the left ventricular functional abnormalities permit a systemic assessment of the disease process on the myocardial performance, provides an objective basis for the risk stratification and the therapeutic strategy, and allows for the sequential follow up of the therapeutic response. ECG gated myocardial single photon emission computed tomography imaging is an state of art technique that allows quantitative or semi-quantitative assessment of the left ventricular function simultaneously with the evaluation of myocardial perfusion1.In order to compare ventricular function derived from ECG gated MP-SPECT with coronary angiography ,this study consisted of 47 patients ,their mean LVEF (S.D) 53% + 17.8 ranged from 21%-89% was found in ECG-gated MP-SPECT group compared to mean(S.D) 46.26% + 16.7 ranged from 20%-80% in coronary angiography group as shown in table-2.Statiscally no significant difference found in ejection fraction measured by ECG gated MP-SPECT group and coronary angiography group(p-value >0.05) as shown in table3-5. KEYWORDS: LVEF (left ventricular ejection fraction), ECG gated myocardial perfusion single photon emission computed tomography, coronary angiography.

cyclic female reproductive functions. Such a rise as well as the difference of leptin levels between control subjects and PMS patients may be due to highly complex interactions between ovarian hormones and the neuroendocrine mechanisms due to neuropeptides and neurotransmitters responsible for food intake, energy expenditure and adiposity during the luteal phase of the menstrual cycle. KEY WORDS: Premenstrual Syndrome, Leptin, Menstrual Cycle Phases

EPIDEMIOLOGICAL AND DIETARY RISK FACTORS OF HEPATITIS C DISEASE IN TANDO ALLAHYAR POPULATION
HIRA KHAN, NASEEM ASLAM CHANNA Institute of Biochemistry, University of Sindh, Jamshoro {E-mail: hirahanif85@yahoo.com} INTRODUCTION: Globally 130 million people are infected with Hepatitis C virus and it is increasing day by day. Hepatitis C virus enters the host (liver) cells and provokes immunological and physiological changes in liver and if not controlled ultimately leads to cirrhosis and Hepatocellular carcinoma. The most efficient transmission is through percutaneous exposure to infectious blood. Some dietary factors involve in prevention of HCV are vegetables, pulses, tomatoes and tea. MATERIALS AND METHODS: 70 Hepatitis C patients and 71 controls (age, sex and locality matched with no personal or family history of hepatitis C) were randomly selected from the TandoAllahyar population during June 2007 to December 2007. A standard questionnaire specially developed for that purpose, was distributed among patients and controls. Accurate rapid card test was performed to confirm HCV positive or negative patients and controls. O.R with 95% confidence interval was computed and p values were calculated by chi square test. RESULTS: Over all findings showed that among 70 HCV patients 64% were females and 36% males (mean age range was 20-48 years). Our results showed strong association of sedentary life style (OR=4, 95% CI, 1.48-10.6, p=0.005), marital status, +ve family history, B+ve blood group, piercing, syringe use (70%), multiple pregnancies (OR=4.72, 95% CI, 1.47-15.15, p=0.008), blood transfusion (OR=4.4, 95% CI, 1.2-14.95, p=0.017), take out food debris by office pins (NS), shave at barber’s shop (NS), dental procedures (NS), medicines used in past (OR=3.08, 95% CI, 1.2-7.71, P=0.016), G.I.T diseases (OR =8.66, 95% CI, 1.2855.58, p=0.023), stones of kidney or gallbladder, jaundice, Tuberculosis and psychological problems (OR =2.5, 95% CI, 1.04-6.13, P=0.04) with hepatitis C disease. We have not found any association of surgery, BMI, ENT, diseases, meat consumption and smoking with the disease. Vegetables OR =0.842, 95% CI, 0.361-1.964, P=0.694), pulses, tomatoes (OR =0.31, 95% CI, 0.041-2.53, P=0.31), and tea (OR =0.598, 95% CI, 0.251-1.431, P=0.25) were found to be the protective factors for Hepatitis C disease. CONCLUSION: Hepatitis C is blood born infection, cause inflammation and destruction of liver. Improved strategies and disease awareness should interrupt HCV transmission.

DENTAL CARIES AND DIABETES MELLITUS: ROLE OF SALIVARY FLOW RATE AND MINERALS
MUHAMMAD JAWED 1, SYED M. SHAHID 2 AND ABID AZHAR 2 1 Department of Biochemistry, Liaquat College of Medicine & Dentistry, Karachi, Pakistan 2 Dr. A. Q. Khan Institute of Biotechnology & Genetic Engineering (KIBGE), University of Karachi, Karachi, Pakistan INTRODUCTION: This study was designed to evaluate the possible protective role of salivary factors like salivary flow rate and adequate level of calcium, phosphate and fluoride in patients of diabetes mellitus type 2 against dental caries. MATERIALS & METHODS: A total of 398 patients of diabetes mellitus type 2 with dental caries and 395 age and sex matched non-diabetic subjects with dental caries were included as controls. All subjects were divided into four groups according to their ages. Decayed, missed and filled teeth (DMFT) were scored to indicate the severity of dental caries. Saliva was collected, flow rate was noted and calcium, phosphate and fluoride were analyzed. RESULTS: The FBS, HbA1c and DMFT indices were found to be significantly high in diabetic patients as compared to controls. The salivary flow rate, calcium, phosphate and fluoride were found to be significantly low where as no significant difference was found in salivary magnesium in patients as compared to controls. CONCLUSION: Optimum salivary flow rate is responsible for establishing protective environment against dental caries. Adequate level of salivary calcium, phosphate and fluoride is also involved in significant deposition of these minerals in plaque which greatly reduces the development of caries in the adjacent enamel of teeth. KEY WORDS: Dental caries, diabetes mellitus, salivary flow rate, salivary minerals.

PLASMA LEPTIN LEVELS IN SUBJECTS WITH PREMENSTRUAL SYNDROME SYMPTOMS
SITWAT ZEHRA1, MANSOOR A. KHAN1, ABID AZHAR1, MASOOD A. QURESHI2 1 Dr. A.Q. Khan Institute of Biotechnology and Genetic Engineering (KIBGE) 2 Department of Physiology, Dow University of Health Sciences (DUHS), Karachi INTRODUCTION: Leptin, a 16 kD cytokine, encoded by the obese gene, is an important metabolic signal affecting the brain energy balance. It is suggestive to be involved in the neuroendocrine regulation of variety of reproductive events and thus may be linked to menstrual cycle and its dysfunctions like Premenstrual Syndrome but many questions remain unanswered. MATERIAL AND METHODS: Female subjects (# 112; age: 21 years) participated in the study to provide information about anthropometric profiles and PMS symptoms on specified prescribed Questionnaire. Fasting blood samples were collected during specific days of follicular and luteal phases on ovulation detection by biphasic BBT pattern, and leptin was determined by EIA Kit. RESULTS: About 60% frequency of PMS is reported. The major symptoms mostly reported for PMS subjects (#68) include: irritability (71%), fatigue (87%), breast tenderness (68%), bowel constipation and loose (37 & 18% respectively), and appetite (up and down 43 and 51% respectively), abdominal bloating (48%). The order of frequency was different from those reported for western population. Circulating leptin concentrations vary considerably during the physiological menstrual cycle presenting with higher values during the luteal phase. Further, PMS patients depicted significantly higher plasma leptin levels (P .001) in both follicular and luteal phases compared to the controls CONCLUSION: Physiological importance of leptin increase during luteal phase is not clear, but does document that leptin, may have a role in the regulation of

NEUROPROTECTIVE POTENTIALS OF AQUEOUS FRUIT EXTRACT OF SEA BUCKTHRON (Hippophae rhamnoides L. spp. Turkestanica) ON HALOPERIDOL INDUCED NEURONAL ALTERATIONS IN THE STRIATUM
FARHAT BATOOL1, ASAD HUSSAIN SHAH2, SYED DILNAWAZ AHMED2 & DARAKHSHAN JABEEN HALEEM1 1Neurochemistry and Biochemical Neuro-pharmacology Research Laboratory, Department of Biochemistry, University of Karachi, Karachi-75270. Pakistan. 2Department of Plant Breeding and Molecular Genetics, Faculty of Agriculture, Rawalakot, Azad Jammu and Kashmir Pakistan. {Email: batool@uok.edu.pk} INTRODUCTION: Increasing scientific evidence is available to support the hypothesis that certain foods and food components have beneficial physiological and pharmacological effects on brain chemistry. Effects of orally administered aqueous fruit extract from fresh berries of Sea buckthorn (Hippophae rhamnoides L. spp. Turkestanica) (SBT-FE) were investigated for their neuroprotective potentials in the rat striatum (caudate nucleus and putamen) following repeated administration of haloperidol. MATERIALS & METHODS: Rats received daily haloperidol (3.0mg/kg I.P.) and saline (0.9% NaCl) injections for a period of 15 days. 7-day post-treatment, aqueous SBT-FE (40mg/kg) was also administered daily via feeding tube. Hypolocomotive effects (home cage activity, exploratory activity and catalepsy) were monitored consecutively in each group of rats. At the end of the behavioral tests and on the last day of experiments, changes in extracellular levels of striatal dopamine (DA), dihydroxyphenyl acetic acid (DOPAC) and homovanilli acid (HVA) were also determined by HPLC-EC. RESULTS: The results indicate that daily food intake and locomotor activities in novel and familiar environments were significantly (p<0.01) increased in

haloperidol plus SBT-FE administered rats when compared with their respective controls. Significant (p<0.01) decreases were also observed in cataleptogenic effects following 7th and 15th last administration of SBT-FE in haloperidol treated rats. Striatal levels of DA and HVA were also significantly altered in rats administered with SBT-FE. CONCLUSIONS: It is suggested that non-pharmacological stimuli from functional food nutrient of Sea buckthorn may influence neuronal alterations in rat striatum induced by haloperidol and may have the potential for the prevention of neurodegenerative diseases. KEY WORDS: Sea buckthorn (Hippophae rhamnoides), haloperidol, catalepsy, postsynaptic DA-D2 receptors, striatum, schizophrenia.

supplements irrespective of the hemoglobin status of the women. CONCLUSIONS: Prevalence and severity of anemia in pregnant subject attending the tertiary care hospitals of Pakistan is exceptionally high. Current findings highlight the anemia in pregnancy as a priority area of concern. KEY WORDS: Anemia, Hemoglobin, Pregnancy

LONG TERM CONSUMPTION OF SUGAR RICH DIET DECREASES THE EFFECTIVENESS OF SOMATODENDRITIC SEROTONIN-1A RECEPTORS
QURRAT-UL-AEN INAM1, BUSHRA JABEEN1, M.A Haleem2 & DARAKHSHAN J HALEEM1 1Neurochemistry and Biochemical Neuropharmacology Research Unit, Department of Biochemistry, University of Karachi, Karachi 2Department of Biomedical Engineering, Sir Syed University of Engineering and Technology, Karachi INTRODUCTION: 8-hydroxy-2-(di-n-propylamino) tetralin (8-OH-DPAT), a 5hydroxytryptamine (5-HT)-1A selective agonist was used to investigate a possible role of somatodendritic serotonin-1A receptors in the precipitation of hyperphagia and decreases of 5-HT metabolism associated with long term consumption of sugar rich diet. MATERIAL & METHODS: In the first part of study, dose related hyperphagic effects of 8-OH-DPAT were monitored in freely feeding rats. In the second part of study rats were fed freely on sugar rich diet [prepared by mixing standard rodent diet with table sugar in the ratio of 3:1 (w/w)] for five weeks. Hyperphagic effects of 8-OH-DPAT were monitored in sugar rich diet and normal diet treated rats by injecting the drug at a dose of 0.25mg/kg body weight, a dose that produced significant hyperphagia. Effects of 8-OH-DPAT on decreasing 5-HT metabolism in the hypothalamus were also investigated in the two groups. RESULTS: Showed that administration of 8-OH-DPAT at a dose of 0.25mg/kg body weight elicited hyperphagia and decreased 5-HT metabolism in normal diet treated animals but the effects in sugar rich diet treated animals were smaller and not significant. CONCLUSION: Suggesting a decrease in the effectiveness of somatodendritic 5-HT-1A receptors, which provide a feedback control over the synthesis and release of 5-HT in terminal region. Possible mechanism involved in sugar diet induced decreases of 5-HT metabolism is discussed. KEYWORDS: Hyperphagia, 5-HT-1A receptors, sugar rich diet.

ANTI MICROBIAL PROPERTIES IN FERULA FOETIDA
S. HYDER RAZA NAQVI , ASIF BIN REHMAN Department of Pharmacology, Isra University, Hyderabad Department of Pharmacology, Hamdard University, Karachi {E-mail: razahaiderdr@yahoo.com / dr.haiderraza@ hotmail.com} INTRODUCTION: The use of most common traditional medicine Ferula foetida, is believed to be effective in curing bacterial and fungal infection. Therefore, this medicinal plant was selected for the presence of anti microbial properties. OBJECTIVE: Determination of antimicrobial activity of F. foetida. METHODOLOGY: This experimental based study was conducted at Department of Pharmacology, Faculty of Pharmacy, Karachi University, 2005 to 2006. Antibacterial activity was carried out against gram +ve and gram –ve organisms including candida and aspergillus species. Petri plates were prepared with Tryptic Soy Agar and cultures of the organisms were maintained on the stock culture agar. The results of this activity are measured in term of zone of inhibition of crude extract against microorganism. Different fractions (ethyl acetate, chloroform, n-butanol and aqueous factions) from gum resin of F. foetida were prepared for screening the antibacterial and antifungal activities. RESULTS: Ethyl acetate, chloroform and n-butanol fractions show antibacterial activity against gram +ve organisms (zone of inhibition: 10-15mm, 05-10mm, 05-10mm respectively) except aqueous fraction (zone of inhibition: no activity). Gram –ve organisms were found resistant to different fractions of F. foetida except M. catarhalis (zone of inhibition; 01-05mm). Candida and Aspergillus species were found sensitive for antifungal activity of F.foetida (zone of inhibition: 01mm-05mm and 05mm -10mm) respectively with p value (0.005). CONCLUSION: The results reveal the fact that the drug has positive antimicrobial effects and can be utilize against different micro-organisms at appropriate effective dose range. KEY WORDS: Antimicrobial effect, microbial organisms, Ferula foetida, Fractions.

5HT-2C RECEPTOR RESPONSIVENESS IN RAT MODEL OF TD
HUMA IKRAM AND DARAKHSHAN JABEEN HALEEM Neurochemistry and Biochemical Neuropharmacology Research Unit, Department of Biochemistry, University of Karachi, Karachi {E-mail: huma_biochemist@yahoo.com} INTRODUCTION: Tardive dyskinesia (TD) is the major limitation of typical neuroleptic therapy. Rats chronically treated with haloperidol exhibit vacuous chewing movements (VCMs) and are widely used as animal model of TD. MATERIALS AND METHODS: 24 male Albino Wistar rats (weighing 180-220g) were randomly assigned to saline & haloperidol injected groups each containing 12 animals and were repeatedly injected with haloperidol (1mg/ml/kg; twice a day for 2 weeks) or saline (1ml/kg). Two days after withdrawal; animals in each group were again subdivided into m-CPP and saline injected groups each containing 6 animals. m-CPP (3mg/ml/kg) challenge was given to monitor the responsiveness of 5HT-2C receptors. Food intake by the rats (2hr & 4hr post injection) was recorded. Animals were then decapitated (4hr post injection) to collect dorsal striatum and ventral samples for the neurochemical analysis by HPLC-EC. RESULTS: Rats repeatedly injected with haloperidol at the dose of 1mg/ml/kg twice a day for 2 weeks displayed VCMs that increased in a time dependent manner as the treatment was continued for 5 weeks. VCMs were produced. The intensity of m-CPP induced hypophagia was more in repeated haloperidol + m-CPP injected rats after 4hr but not after 2hr post m-CPP challenge. m-CPP also attenuated haloperidol induced increased dopamine and 5-HT metabolism both in dorsal and ventral striatum. However, these effects were more pronounced in ventral striatum. CONCLUSION: In conclusion, present study provides evidence that 5HT-2C receptors become hypersensitive in a rat model of TD. Findings may help in extending the therapeutics in schizophrenia.

HEMOGLOBIN STATUS OF PREGNANT WOMEN VISITING TERTIARY CARE HOSPITALS OF PAKISTAN
DILEEP KUMAR ROHRA1, NAZIR AHMED SOLANGI 2, ZAHIDA MEMON 3, NUSRAT H. KHAN 4, SYED IQBAL AZAM 5, KANYA LAL AHUJA1 1Department of Biological and Biomedical Sciences, Aga Khan University, Karachi 2Department of Pharmacology and Therapeutics, Nawabshah Medical College, Nawabshah 3Department of Gynecology and Obstetrics, Dow Medical College and Civil hospital, Karachi 4Department of Community Health Sciences, Aga Khan University, Karachi {Correspondence: Dr. Nazir Ahmad Solangi, Professor of Pharmacology, Liaquat National Medical College & Hospital, Stadium Road; Karachi. Cell # 03003331300} OBJECTIVE: To determine the status of hemoglobin levels in pregnant women who visited tertiary care hospitals of various cities in Pakistan for their antenatal care from January 1 to April 30, 2007 Place and Duration: This was a descriptive cross sectional multi-center study. METHODS: This study was conducted at the Aga Khan University Hospital (AKUH), Civil Hospital, Karachi (CHK) and Nawabshah Medical College Hospital (NMCH), Nawabshah. Copies of medicinal prescriptions given to pregnant patients attending the antenatal clinics were collected from January 1 to April 30, 2007. Reports or results of hemoglobin concentrations were also obtained from the patients. RESULTS: A total of 1709 pregnant women were recruited. Majority 1145 (67%) were from the age group of 25 to 34 years and 1555 (-91%) had some degree of anemia. The number of women with moderate to severe anemia (hemoglobin levels < 8 or 8-9.9 gm/dl) was statistically more frequent in second and third trimester, while mild anemia (hemoglobin levels of 10-10.9 gm/dl) was more in first trimester of pregnancy. The distribution of severe anemia however; was not different is the three trimesters. About 90-92% subjects received iron/vitamin/mineral

ASH AS A UNIQUE NATURAL MEDICINE FOR WOUND HEALING
DIN MUHAMMAD SHAIKH* & HAMID ZIA SHAIKH**. Department of Physiology, Isra University, Hyderabad* Department of Physiology, Isra University, Hyderabad** {E.mail: hamidziashaikh@yahoo.com} BACKGROUND: In treatment of surgically induced wound in rabbit skin wound model, the application of different ashes had a better all round response and recovery observed in speculated time i.e. 11-13 days. METHOD: Ashes were prepared from dried buffalo dung, wood and charcoal and their contents were analyzed with Atomic Absorption Spectrophotometry. Besides the application of an anti-bacterial ointment as control, all the three types of ashes were used as experimental applications on the induced rabbit skin wounds, on different sites respectively. RESULT: Consistent healing was observed in all the experimental wound sites, which was comparatively rapid than control wound site. The healing was deemed complete on 11th day only with Charcoal Ash whereas for Dung-cake ash and Wood Ash the completion time was approximately. 13 days. CONCLUSION: Ashes have unique properties to influence and enhance safe and sepsis free wound healing in rabbit skin wound model. KEY WORDS: Ash, Rabbit, Skin Fibroblasts, Anti-bacterial ointment.

parameters (known to be consistently elevated in myocardial ischemia) in normal subjects and subjects with CAD in the Pakistani population. 2. To correlate serum resistin levels with severity of CAD. METHODS: Ninety patients with CAD were enrolled and divided into three equal subgroups: Acute Myocardial Infarction (AMI), Unstable Angina Pectoris (UAP), and Stable Angina Pectoris (SAP). Thirty healthy people were recruited as controls in this cross sectional study. Serum resistin and hsCRP were determined by ELISA (Enzyme linked immunosorbent assay) and Creatinkinase MB, Troponin I, CBC, Lipid profile and fasting blood sugar were measured using standard laboratory methods. RESULTS: Serum resistin levels were highest in patients with AMI, less in UAP and still less in SAP ad lowest in controls (p=0.001). Therefore weshow that serum resistin increases with increasing severity of CAD. Serum resistin levels also correlated with hsCRP(p=0.001), WBC count (p=0.001), CKMB (p=0.001) and Trop I (p=0.001), Results also show that serum resistin levels increase with increasing FBS. CONCLUSION: Serumresistin levels increased with increasing severity of CAD. Serum resistin levels were also found to increase in parallel with otherinflammatory markersknownto be increased in myocardial ischemia such as hsCRP, WBC count, CKMB and Troponin I, These results suggest that the hormone resistin might play an important role in the pathogenesis of atherosclertosis and AMI as a inflammatory marker.

TO INVESTIGATE THE ASSOCIATION OF SERUM ADIPONECTIN LEVELS IN CORONARY ARTERY DISEASE
DR. HUMAIRA NAWAB Department of Physiology Karachi Medical & Dental College Block M North Nazimabad Karachi AIM: To investigate the association between risk of coronary heart disease and serum levels of adiponectin. STUDY DESIGN: Cross-sectional, case control study. PLACE OF STUDY: Department of Physiology BMSI JPMC in collaboration with Abbasi Shaheed Hospital Karachi METHODOLOGY: This study included total 100 subjects, 50 subjects with angiographically confirmed coronary heart disease and 50 normal healthy age and gender matched controls RESULTS: Adiponectin serum concentration was found lower in coronary disease patients when compared with control subjects. (7.10) versus (11.98). CONCLUSION: This suggests that higher level of serum adiponectin is protective against the development of coronary heart disease.. KEY WORDS: Coronary heart disease, Adiponectin, Case Control study.

DNMT1 SILENCING AFFECTS LOCUS SPECIFIC DNA METHYLATION AND INCREASES PROSTATE CANCER DERIVED PC3 CELL INVASIVENESS
SALMAN FAROOQ, AHMED YAQINUDDIN, SOHAIL A. QURESHI, ROMENA QAZI, & FARHAT ABBAS Aga Khan University Hospital, Karachi PURPOSE: DNMT1 maintains genomic DNA methylation at 5'-CpG-3' residues in somatic cells. Recent findings revealed that DNMT1 depletion causes distinct phenotypic changes in colon and gastric cancer cell lines, suggesting that the extent to which DNMT1 influences the expression of its target genes is cell-type specific. We determined the impact of DNMT1 depletion in prostate cancer derived cells on their gene expression profiles and cellular phenotype. MATERIALS AND METHODS: Small interfering RNA was used to silence DNMT1 expression in prostate cancer derived PC3 cells (ATCC™). The resulting cell line was validated by reverse transcriptase-polymerase chain reaction and Western blotting. Proliferation, migration and invasion assays were done in engineered cells to asses the effect of DNMT1 silencing on cellular phenotype. DNA microarrays were done to monitor changes in gene expression. RESULTS: Our data showed that DNMT1 loss dramatically decreased cell proliferation but significantly increased cell migratory and invasive potential. Additionally, in the limited set of genes whose expression and DNA methylation status were determined DNMT1 loss was associated with increased CDKN3 and claudin-3 expression, and also culminated in specific demethylation of Rb1 and RAR-â promoters. CONCLUSIONS: These results show that the genetic and phenotypic consequences of silencing DNMT1 in PC3 cells are markedly different from those in colon and gastric cancers, indicating that DNMT1 preferentially targets certain gene promoters. Our findings also suggest that decreasing DNMT1 levels or activity can potentially enhance prostate cancer cell invasiveness.

RELATIONSHIP BETWEEN RESISTIN LEVELS IN HEALTHY CONTROLS AND IN MYOCARDIAL ISCHEMIA
KHALID SAYEED, PERVAIZ SANDILA, AKBER KHOJA, SHAKOOR MEMON Department of Physiology, BMSI Jinnah Postgraduate Medical Centre, Karachi BACKGROUND: The incidence and prevalence of coronary artery disease is increasing worldwide. Alarmingly it is reaching epidemic proportions. Since the 1960s a number of risk factors have been implicated in the aetiology of Coronary Artery Disease (CAD), from that time cardiovascular risk prediction has relied on high blood pressure, smoking status, hyperlipidemia and diabetes mellitus as the core risk factors, proposed by the Framingham Heart study in the 1960s with corroborating evidence from major studies performed worldwide, these risk factors and their interactions with age and sex were formally codified in the 1980s into the Framingham Risk Score. However, it has become increasingly clear that there are limitations to this approach. First it is widely recognized that 20% of cardiovascular events occur among individuals in whom traditional risk factors are not present. Moreover the specificity of traditional risk factors is limited. Multiple studies additionally confirm that most vascular events occur among individuals who on the basis of Framingham risk score are at intermediate risk constitute a very large heterogeneous group which needs better methods for risk stratification. Finally the relationship between Framingham scores and absolute risk for CAD varies across populations. For all of the above reasons there has been a need to develop novel risk factors that improve global risk predication. The newly discovered hormone “Resistin” is one such novel risk factor. Recent reports suggest that resisting is increased in CAD and obesity. OBJECTIVES: 1. To investigate the correlation of circulating resistin levels with other metabolic

ANALYSIS OF P53 GENE MUTATIONS/POLYMORPHISMS IN ORAL SQUAMOUS CELL CARCINOMA (OSCC) IN PAKISTAN
SAIMA SALEEM1, ABDUL HAMEED2, MUHAMMAD AJMAL2, NAVID RASHID QURESHI3, ZUBAIR ABBASI4 AND ABID AZHAR1 1Dr. A. Q. Khan Institute of Biotechnology and Genetic Engineering (KIBGE), University of Karachi, Karachi 2Institute of Biomedical and Genetic Engineering, 24-Mauve Area, G-9/1, Islamabad 3Liaquat College of Medicine and Dentistry, Karachi 4 Karachi Medical and Dental College, Karachi INTRODUCTION: Oral squamous-cell carcinoma (OSCC) is among the common neoplasm in Pakistan. Epidemiologic evidence indicates a direct relationship between tobacco smoking, chewing of betel leaves (paan), betel nut (chaliya), niswar and gutka, with oral carcinogenesis, suggesting that there may be specific genetic targets of betel-quid ingredients. The p53 gene has been indicated to be a tumor-suppressor gene that is found in mutated form in common human cancers. However, there are few reports about "carcinogen-specific" p53 mutation. MATERIALS AND METHODS: Tissue and blood specimens were collected from 250 OSCC patients, with informed consent, from local hospitals of Karachi and

were used for p53 mutation analyses. Exons 4, 5 and 6 of p53 genes were examined by polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) and direct sequencing. RESULTS: The PCR-SSCP analyses showing mobility shift bands in tumor samples were purified and directly sequenced. In exon 4 of the p53 gene, a C to G missense mutation at nucleotide position 215 of the coding sequence was identified. CONCLUSIONS: This change substitutes amino acid proline with arginine at position 72 of p53 protein. The change was significantly observed in OSSC tumor sample that may be responsible for causing OSCC in Pakistan. KEY WORDS: p53, OSCC, PCR-SSCP, DNA sequencing, and mutation

tissue sections were obtained on Poly-L-Lysine coated glass slides. Antigents retrieved by HIER techniques and stained with immunostins anti CD3 and CD79 a for the precise localization of T and B-lymphocytes. RESULTS: Immunostaining shows decreased size and cellularity with apoptosis, necrosis and mitotic figures on H & E stain in-group B. Where as group C, shows comparable structure with the control group. The plasma ACTH level in Group B increased significantly (67.63 +- 0.69 pg/ml) in-group C. CONCLUSION: These findings suggest that Cyanocobalamin has important immunomodulatory effects on immunity and abnormalities in the immune system in heat-stressed models are restored by Cyanocobalamin therapy. KEY WORDS: Heat, Stress, Spleen, ACTH, Cyanocobalamin.

INDUCTION OF PLURIPOTENT STEM CELLS FROM HUMAN FIBROBLASTS AND HEPATOCYTES BY ECTOPIC EXPRESSION OF DEFINED TRANSCRIPTION FACTORS USING ADENO ASSOCIATED VIRUS (AAV)
1AFTAB AHMAD, 2EDILAMAR D OLIVERA, 3KEPING QIAN, 1A.R. SHAKOORI, 3IAN M PHILLIPS 1School of Biological Sciences, University of the Punjab, Lahore, Pakistan 2University of São Paulo , Brazil 3Keck Graduate Institute of Applied Life Sciences, CA. USA INTRODUCTION: Production of induced pluripotent stem cells (iPSC) is a breakthrough in biological sciences. iPSC generation has great potential for basic and clinical sciences. There is a possibility of nuclear reprogramming using somatic cell nuclear transfer technology and fusion of embryonic stem (ES) cells with mature cells but potential of these approaches was hindered by technical complications and ethical concerns. Main objective of iPSC production is the derivation of “customized” embryonic stem cells for patient specific cell treatment. MATERIAL AND METHOD: An attempt has been made to induce in vitro reprogramming of human fibroblasts and hepatocytes by ectopic expression of four transcription factors, Oct4, Sox2, Klf4 and c-Myc by Adeno Associated Virus (AAV). Exogenous expression of these genes was studied by PCR. iPSC production was also analyzed with or without expression of c-Myc (a transcription factor). Immunostaining of colonies was done. RESULTS: ES cells like colonies were observed in both fibroblasts and hepatocytes. iPSC colonies were confirmed by immunostaining with ES cell markers (Oct-4, SSEA-4,TRA-1-60 and TRA-1-81). iPSC colonies were also generated using Oct-4 promoter and Geneticin (G480) as selectable marker. CONCLUSION: Our results indicate that iPSC can be generated by ectopic expression of three TF in mature human cells. There is further need of in vivo study to test these iPSC for germ line transmission and teratoma formation and in vitro differentiation into all the three germ layers. KEYWORDS: Embryonic stem cells, Induced pluripotent stem cells, Transcription factors, gene expression.

FORMALDEHYDE EXPOSURE LEVEL IN THE GROSS ANATOMY DISSECTING ROOM AT COLLEGE OF MEDICINE KING SAUD UNIVERSITY RIYADH
MUHAMMAD SAEED VOHRA Assistant Professor, Stem Cell Unit Department of Anatomy, College of Medicine King Saud University, Saudi Arabia {Email: vohra@ksu.edu.sa} INTRODUCTION: This study was conducted to correlate the personal formaldehyde (FA) exposure levels of instructors and students with the indoor FA concentrations in gross anatomy laboratory at College of Medicine, King Saud University. The personal FA levels of instructors and students are higher than the indoor FA concentration in the gross anatomy laboratory. MATERIALS AND METHODS: The gross anatomy laboratory at college of medicine, King Saud University Riyadh, was observed for indoor FA concentration and the personal exposure levels of instructors and the medical students during the 4th 10th and 14th weeks of the dissection sessions. All air samples were collected by the diffusive sampling device and analyzed by using high performance liquid chromatography (HPLC). RESULTS: The personal exposure level of FA was higher than the indoor concentration, and the personal exposure levels of instructors were higher than that of the students. The concentration of FA was also higher in the center of the room than the corners and near the doors. CONCLUSION: Both the indoor FA concentrations and the degree of personal FA exposure levels are higher near the dissecting table than a point away from it during the gross anatomy laboratory sessions. Thus the instructors and students are exposed to the higher concentration of FA than the general population.

EXPRESSION OF CD CELL SURFACE MARKERS FOLLOWING GABAPENTIN TREATMENT IN MODEL OF AIA RATS
SAMEERA KHURSHID AND SHABANA USMAN SIMJEE H.E.J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi INTRODUCTION: Chronic pain is a group of heterogeneous persistent symptoms that may arise due to imbalance of neurotransmitter release of excitatory (glutamate) and inhibitory (GABA) origin. Moreover, cluster differentiation (CD) markers are also reported to be involved in the progression of chronic inflammatory pain. During inflammatory process, the expression of CD markers has been shown to be altered due to the alteration in GABAergic neurotransmission. In the present study, we have investigated the effect of GABA analog “gabapentin” (GBP) treatment alone or as an adjunct therapy on the modulation of chronic arthritic pain and on the expression of CD29, CD44 and CD90 markers in the arthritic rats. To our knowledge, much of the work done on the up-regulation of CD markers was carried out in the synovial fluid aspirate from the inflamed joint. However, we have evaluated the effect of GBP on the expression of these markers in the brain of arthritic rats. MATERIAL AND METHODS: The arthritis was induced in SD rats using complete Freund’s adjuvant. The progression of the disease was monitored by measuring body weight and paw volume, whereas, the nociception was measured by Plantar Test. At the end of the study, animals were sacrificed and the brain samples were collected for immunohistochemical analysis of CD markers. RESULTS: It was observed that however, the treatment of GBP as a single agent did not inhibit the macroscopic changes i.e., erythema and swelling of limbs, but it significantly reduced the hyperalgesia in the arthritic rats measured by Plantar Test. Moreover, when it was given as a combination therapy with low dose of indomethacine, a significant reduction (P<0.05) in the paw volume was observed. Immunohistochemical analysis revealed a marked decrease in the CD29, CD44 and CD90 expression in the GBP treated arthritic rats compared to the arthritic

IMMUNOPROTECTION OF HEAT-INDUCED SPLENIC-TISSUE BY CYANOCOBALAMIN IN ALBINO RATS: AN IMMUNOHISTOLOGICAL STUDY
DR. ABDUL HAFEEZ & DR. ANJUM NAQVI Department of Anatomy, BMSI Jinnah Postgraduate Medical Centre, Karachi OBJECTIVE: The aim of study was to evaluate the immunoprotective role of Cyanocobalamin on the detrimental effects of heat-induced stress on splenictissue. INTRODUCTION: In these days of global warming the heat injury is a major public health issue. Heat stress had more effects on immune responses, lymphoid organs and pathophysiology of white blood cells. Elevated plasma ACTH and corticosterone are the key indicators of the stress condition. Studies on the spleen have increased owing to the immune system with which it is involved. The concentration of the antioxidant vitamins decrease with heat stress. Cyanocobalamin is essential for DNA metabolism, a necessary step in the replication of genes. Cobalamins are intracellular antioxidants; prevent apoptosis of lymphocytes, and acts as an antimutagenic agent. MATERIAL & METHODS: The study was conducted from December 2008 to July 2009. A total of 30 male albino rats between 60-90 days were selected and divided into control (A), heat-induced (B) and protective (C) groups. Group B animals received heat between 40-45 C for 6 hours daily and group C animals received heat and protection with Cyanocobalamin 0.8 mg /kg daily for 6 weeks. Animals then sacrificed, blood samples were colleted in EDTA K3 containing vacutainers for plasma ACTH assay, Formalin fixed paraffin-embedded, splenic-

control group. CONCLUSION: Based on these results, we suggest that GBP might control the underlying mechanism of the inflammatory processes associated with arthritis. When given as an adjunct therapy with NSAIDs (indomethacin), GBP has profound effect on both the nociception and inflammation where NSAIDs act to relieve the underlying inflammatory reactions and GBP act centrally to inhibit the pain transmission. In addition, the determination of CD molecules in brain samples can also be a strong predictive marker of the inflammatory processes involved in arthritis.

million HBV carriers. There is no data available yet on prevailing genotypes of the HDV strains in Pakistan. The present study was aimed to identify the most prevalent genetic strain of Hepatitis Delta Virus in Pakistan. MATERIALS & METHODS: In this study hepatitis delta virus RNA of 200 patient’s sera were analyzed by RT-nested PCR. It is based on sequence variation within the coding region of hepatitis delta antigen of delta virus RNA genome. DNA amplified from patients was digested with restriction enzymes to detect any Restriction Fragment Length Polymorphism. RESULTS: Out of 200 HBV ELISA positive patients 76 (38%) were positive for hepatitis delta virus RNA by RT-nested PCR while genetic variants of type I have been found by RFLP. Conclusion: In present study, data indicate the prevalence of genotype I among delta positive sera which is about 97.5%. KEYWORDS: HDV, genotype, RT-nested PCR.

AC-31B SUPPRESSES THE ALTERATIONS IN BONE MARROW CELL FUNCTIONS INDUCED BY KINDLED SEIZURES
SYED UZAIR ALI SHAH1, RAHEELA KHAN1, SIDDIQUA JAMALL3, ASMAT SALIM2, & SHABANA U. SIMJEE1,2 1H.E.J. Research Institute of Chemistry 2Dr. Panjwani Center for Molecular Medicine & Drug Research, International Centre for Chemical & Biological Sciences, University of Karachi, Department of Biochemistry, University of Karachi, Karachi INTRODUCTION: The bone marrow (BM) provides microenvironment for proliferation and differentiation of hematopoietic stem cells and any changes in the BM microenvironment could have an impact on the immune system. Studies have suggested a linkage between seizure activity and alterations in immune functions which may be due to disruptions of BM functions. The present study was carried out in order to determine the effects of chronic seizures on the BM cells and whether such changes are likely to be controlled by treating the kindled mice with AC-31B (oil from Allium cepa). MATERIALS AND METHODS: NMRI mice were kindled by injecting pentylenetetrazole (PTZ, 50mg/kg) on alternate days until seizure score 4-5 develops. At the end of each experiment, animals were sacrificed and cell suspension from femurs were prepared and cultured until cells attained confluence. The cultured cells were used for immunostaining and RT-PCR analysis of CD29, CD44 and CD90. The whole blood and BM aspirate was also used to isolate the mononuclear cells for clonogenic assay. RESULTS: A significant increase (P<0.05, F=5.36) in the cellularity of the BMCs from untreated kindled animals was observed compared to normal control group. We also observed a marked reduction of BM cellularity in diazepam treated animals (P<0.02) compared to normal and AC-31B treated animals. After observing hyperproliferation of BM progenitors in PTZ-kindled mice, we next determine if there was change in the marrow stroma. An increase in stromal cells in the PTZkindled animals (P<0.01) relative to the normal control mice supports the hyperproliferation of BM progenitors observed in this group. Since we observed changes in BM cellularity, we next determined if the effects of seizures were extended to dysfunction in the immature progenitors. One-way ANOVA for clonogenic assays from peripheral blood and BMNCs showed that the groups differed significantly in total numbers of colonies. Post hoc analysis indicated that untreated kindled mice had a significantly higher colony number (P<0.02, F=4.81) relative to normal and AC-31B treated animals. In contrast, kindled and un-kindled mice treated with diazepam showed reduced number of clones compared to other groups. Immunohistochemical and RT-PCR analysis of cultured cells demonstrated increased expression of CD29, CD44 and CD90 in PTZkindled group. In contrast, the expression of these molecules was found to be reduced in diazepam and AC-31B treated kindled animals. CONCLUSION: The present study has provided evidence suggesting that immune alterations in epilepsy could be due, in part, to changes in BM functions and it can be modulated by appropriate anti-convulsant use which avoids the effect on normal hematopoiesis.

COMPARISON OF POTASSIUM HYDROXIDE MOUNT AND M Y C O L O G I C A L C U LT U R E W I T H H I S TO PAT H O L O G I C EXAMINATION USING PERIODIC ACID-SCHIFF STAINING OF THE NAIL CLIPPINGS IN THE DIAGNOSIS OF ONYCHOMYCOSIS
RAZIUDDIN AHMED, SALEEM AHMED KHARAL, MUHAMMAD ASIF DURRANI, FAKHARUDDIN Department of Microbiology, BMSI Jinnah Postgraduate Medical Centre, Karachi OBJECTIVE: Comparison of potassium hydroxide mount and mycological culture with histopathologic examination using periodic acid-schiff staining of the nail clippings in the diagnosis of onychomycosis SETTING: Study is carried out on fifteen patients in the Department of Microbiology, who were clinically diagnosed as a case of Onychomycosis with the collaboration of Dermatology department (JPMC) and Pathology Department, BMSI, JPMC. METHOD: Specimen were taken from the department of dermatology and processed for the diagnosis by potassium hydroxide mount and mycological culture in the department of Microbiology, BMSI, while histopathological examination using Periodic acid-Schiff stain were performed in Pathology department, BMSI. Potassium hydroxide mounts was microscopically evaluated for the presence of thread-like branching structures (hyphae) or beaded spherical structures (spores). If present, it was considered as a positive test. Mycological culture was done using Sabouraud's dextrose agar at 25ºC and at 37ºC. Observation for growth was done periodically for 4 weeks; if growth was present then the pathogen was identified by cultural characteristics and microscopy. PAS staining was done in Pathology department, BMSI. Presences of intensely stained reddish dots or threadlike structures in between the cells of the nail plate were considered to be a positive result. One was immunocompromised patient having Diabetes mellitus Fifteen patients who were clinically diagnosed as a case of onychomycosis were included in the study. Among these patients ten (66.66%) were female and five (33.33%) were male. Age distribution was; eight (53.33%) patients were between the ages 14-24 years and four (26.66%) were between 25-35 years of age, two (13.33%) between the ages of 36-50 years while one (6.66%) patient was of more than 50years of age. Minimum age was 14 years while maximum was 60 years. All were immunocompetent patients while only. RESULT: KOH mount shows fungal element in ten specimens while in six patients the culture was positive. Histopathological examination using Periodic acid-Schiff stain was positive in specimens. CONCLUSION: KOH mount is more effective than the fungal culture. KEY WORD: Onychomycosis, KOH mount, Fungal culture, PAS stain

GENETIC VARIANTS OF HDV STRAINS IN PAKISTAN
SHADAB PERVEEN1, WAQARUDDIN AHMED2, AMBREEN ARIF2, ISRAR NASIR3 SYED M. SHAHID1, ABID AZHAR1 HUMA QURESHI 2 & OBAID YUSUF KHAN3 1The Karachi Institute of Biotechnology & Genetic Engineering (KIBGE), University of Karachi, Karachi 2PMRC Jinnah Hospital 3Department of Genetics, University of Karachi, Karachi-Pakistan INTRODUCTION: HDV is the smallest identified animal virus that is composed of 1.7kb circular negative sense RNA genome that requires Hepatitis B surface antigen for its replication and assembly. The infection caused by delta virus is called hepatitis D which essentially requires the presence of Hepatitis B virus. Presence of hepatitis D virus increases the severity of infection by about 7080%, compared to hepatitis B alone. The variable patterns of Hepatitis D from mild to severe depend on three genetic variants of delta virus that have been identified so far. The incidence of Hepatitis D infection in Hepatitis B patients and carriers is rising in Pakistani population. A study carried out in Karachi, showed the prevalence of Hepatitis Delta Virus (HDV) which is about 17% of 4.9

EMERGING RESISTANCE IN HELICOBACTER PYLORI ISOLATED FROM GASTRIC BIOPSIES IN PUBLIC SECTOR GASTROENTEROLOGY UNIT OF KARACHI, PAKISTAN
TARANUM RUBA SIDDIQUI, WAQUARUDDIN AHMED, SAFIA BIBI Pakistan Medical Research Council Jinnah Postgraduate Medical Centre, Karachi OBJECTIVE: The aim of this study was to estimate the susceptibility pattern of Helicobacter pylori against commonly prescribed antibiotic. METHOD: It was a prospective study carried out in gastroenterology unit of PMRC, JPMC, Karachi from March 2008 to June 2009. Total 445 patients presenting symptoms of gastroduodenal diseases underwent endoscopy for the diagnosis. Biopsies were taken for CLO, Culture & sensitivity test. Sensitivity was performed by disc diffusion method. MacfarLand 4 of Helicobacter pylori culture suspension was used to make lawn prior to place antibiotic disc. The Sensitivity test was done for following commonly prescribed antibiotic, Amoxicillin, Clarithromycin, Tetracycline, Metronidazole, Ofloxacin, and Furazolidone. Plates

were incubated at 37 C in microaerophilic condition for three days. RESULTS: Total of 445 cases in which 211 (47.4%) were male and 234 (52.58%) were female. Helicobacter pylori were isolated from 80 cases (17.9%). Resistance pattern was 27.2%, 16.36%, 98.18%, 9.0%, 1.8%, & 5.4% against Clarithromycin, Furazolidone, Metronidazole, Ofloxacin, Amoxicillin, & Tetracycline respectively. Intermediate pattern of isolates were seen 1.8%, 7.27%, 21.8%, & 10.9% against Tetracycline, Amoxicillin, Ofloxacin, Furazolidone, respectively. The frequency of triple- & quadruple resistant Helicobacter pylori isolates was 9.05% and 36.36% were resistant to more then one drug. CONCLUSION: The increased resistance of Helicobacter pylori against commonly prescribed antibiotics is very alarming. Present study shows Amoxicillin and tetracycline is effective against Helicobacter pylori and it can be use as an alternative for the treatment of H.pylori infection.