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Objectives: To observe the effects of different combinations of medicines in GERD patients by using FSSG score. Study Design: Observational Study. Setting: Al-Tibri Medical College Hospital, Isra University Karachi Campus Karachi. Period: June 2017 to December 2017. Material & Methods: The study was conducted on GERD patients at Tertiary Care Hospital of Karachi. Adult patients from male and female gender with clinical symptoms suggestive of GERD were included. During clinical history taking patients were interviewed to respond symptoms frequency of FSSG questionnaire score from 0 to 4 on each question. All 154 eligible patients enrolled in the study and divided into three groups Group I (PPI alone), Group II (PPI with prokinetic) and Group III (PPI, prokinetic and SSRI). After 2 weeks of treatment, FSSG score of every participant was calculated. Results: Results of 134 patients 72 (53.3%) males and 63 (46.7%) females were analyzed. The cumulative mean age was 37.12±8.221 (range 16 – 60) years. The patients were grouped by single blind randomization method, each group I and group II consisted of 45 subjects and 44 patients were enrolled in group III. The mean FSSG score prior to treatment and after treatment was 21.194±4.786 and 14.962±3.696 respectively, hence, the gradient of pre-treatment and post-treatment was 6.231±4.601. The three groups shown significant improvement in FSSG score after treatment but the group III had shown highest improvement in mean FSSG score of 7.522±3.592, followed by group II with 7.2889±3.805and group I had shown the lowest improvement of 3.911±5.346 but statistical analysis revealed these improvements within each group as insignificant while turned to be significant when groups were analyzed with each other. (p 0.003). Conclusion: The results of this study suggests that PPIs alone have good therapeutic role but as dysmotility aspect of GERD and psychological comorbidity is very common in those patients and is likely to play an important role in response, or failure of response, to proton pump inhibitor treatment. Hence, addition of prokinetic and anxiolytics can augment the response rate.

Objectives: To determine the effectiveness of tube drain compared with conventional suturing on postoperative complications after extraction of impacted mandibular third molars. Study Design: Cross Sectional study (Comparative). Setting: Department of Oral & Maxillofacial Surgery, Institute of Dentistry, LUMHS Jamshoro/Hyderabad. Period: Six months duration from 12-11-2015 to 13-05-2016. Material & Methods: All the patient age from 18 to 45 years irrespective of gender, having mesioangular impacted mandibular third molar were included in the study. Patients were divided into two groups, Group-A and group-B. The severity of pain was recorded by using Visual Analog Scale from 0 no pain to 10 worst pain, degree of swelling was measured by facial size through Amin and Laskin criteria and mouth opening was measured by interincisal distance through ruler. All data was recorded on the 3rd and 7th day by the clinician. Results: Mean age of group A was 31.22+7.21 years, and mean age of group B was 28.34+5.33 years. Male were found slightly more as compared to female. On 3rd day the post-operative pain assessment was almost equal in both groups p-value 0.06 and assessment of post-operative swelling on 3rd day was found with insignificant difference p-value 0.22. Assessment of pain on 7th post-operative day was that the severe pain was found significantly reduced in group B as compared to group A p-value 0.01, swelling was significantly reduced in group B p-value 0.04. While mouth opening was also found significantly more in group B as compared to group A p-value 0.022. Conclusion: After removal of impacted mandibular third molars, incorporating tube drain is very effective as compared to conventional suturing in reducing the facial swelling, trismus and postoperative pain.

Objectives: Outcome sclerosing agent for managing the oral pyogenic granulomain terms of post-operative pain, post-operative healing and post-operative infection. Study Design: Cross-section study. Setting: Department of Oral & Maxillofacial Surgery, Institute of Dentistry, Liaquat University of Medical & Health Sciences Jamshoro / Hyderabad. Period: October 2018 to March 2019. Material & Methods: Patients with oral pyogenic granuloma and willing to contribute in study were included. Sclerosing agent (ethanolamine oleate) was taken in 3cc disposable syringe and injected in each lesion once a week and repeated according to need. Patients were fooled for 1 to 3 weeks. Outcome was assessed in terms of post-operative pain, post-operative healing and post-operative infection. Data was recorded in proforma. Results: Total seventy four patients were included; their mean age was 40.67+4.99 years. Males were in majority 59.5%. On 1st week 32 showed mild pain which was markedly decreased on 2nd and 3rd week almost among all patients. On 1st week healing was achieved by all cases. Infection was occurred in 4 patients and fever was noted in 12 cases. On 2nd week infection was occurred in 2 patients and fever was in 04 cases. On 3rd week infection was noted in only one cases and fever not found. Conclusion: It was concluded that sclerosing agent ethanolamine oleate is better treatment option than surgical removal with lower rate of pain, best achievement of post-operative healing and lower rate of post-operative infection for the oral pyogenic granuloma management.

Objectives: Investigating the Adverse effects of non-branded soft drink on therenal histology in an albino rat model. Study Design: Experimental study. Place and Duration:Department of Anatomy, Isra University, in collaboration with Animal House, Department ofAnimal Husbandry and Veterinary Sciences, Sindh Agriculture University Tando Jam over sixmonths duration 2014. Methodology: A sample of 30 adult Wistar albino rats of was selectedaccording to criteria. Animals were randomly divided into 3 groups. Group A (n=10) controlrats, Group B (n=10) control rats given normal diet (12 hours fasting) and Group C (n=10)experimental rats. 3- 5 μ thick renal tissue sections were prepared, stained with H & E andexamined by light microscopy. Data was analyzed on statistical software SPSS 21.0 ver(IBM, incorporation, USA) at 95% (α)-level significance was taken at P-value ≤ 0.05. Results:Experimental group C showed an increase in kidney size and weight observed even after 12hours of fasting (P=0.0001). Histological examination of experimental kidneys show gapingBowman`s capsules, interstitial edema, glomerular distortion, calcifications, acidophilichyalinization of renal tubules, vacuolization of epithelial cell, pyknotic nuclei and necrosis.Epithelial cells revealed fragmentation and sloughing in experimental rat kidney. Conclusion:The present study reports deleterious adverse effects of non-branded soft drink on the renalhistology in an experimental albino rat model.

Objectives: Investigating the Renoprotective effects of Ascorbic acid ingentamicin induced renal injury (GIRI) in male Wistar rats. Study design: Experimental study.Place and Duration: Animal house of Al-Tibri from September 2016 to December 2016.Methodology: 60 male Wistar rats were selected by non-probability purposive sampling,and were divided into three groups; Group A- control, Group B- Gentamicin induced renalinjury (GIRI) (70 mg/kg/bwt i.m) daily , and Group C- GIRI + AA (Ascorbic acid - 0.2 mg/kg/bwt) daily. Cardiac puncture was performed by a Disposable Syringe for blood sampling.Sera were used for biochemical testing. Renal tissue was stained with H & E for histologicalexamination. Statistix 8.1 software (USA) was used for data analysis at P≤ 0.05. Results:Blood urea and serum creatinine were elevated in the group B (GIRI) compared to GIRI+AAand the controls (P=0.0001). Serum superoxide dismutase, glutathione peroxidase, andcatalase were low in GIRI compared to GIRI+AA and control groups. Renal tissue in ascorbicacid treated rats showed improved tissue architecture. Conclusion: It is concluded that theAscorbic acid exerts Renoprotective effects in gentamicin induced renal injury in rat model.

Ageing is exactly the organic process of growing older and showing the effectsof increasing age. The state of Pakistan is caught in the complicated web of various socioeconomicand political problems. In such scenario, efforts to voice the rights of elderly seema bit surprising and out-of-priority box. Objective: The paper attempts to serve as an eyeopenerfor the policy makers both in public and private sectors to interrelate the factors deemedimperative for taking concrete steps to redress the menace arising out of ignoring ageingand dropping it from the national development agenda. Materials and Methods: Structuredinterview schedule was developed to collect information on Older Persons’ health, economicand psychological status. In this regard, an extensive questionnaire was designed and pretestedvigorously. Study Design: This paper is extracted out of the base-line exploratory study.Setting: Rawalpindi city. Period: Oct 2013 to Dec 2013. Results: 69.3% OPs reported variousdiseases, 19.7% respondents never visited the doctor. 25.1% respondents’ last visit to thedoctor was between six months to more than a year. 15.3% visited the doctor for a medicaltreatment. Older persons with no permanent income made them more vulnerable to suffervarious illnesses. Conclusions: Pakistan is not an aged-friendly country that even lacks a policyat national level for the welfare rights of older persons.

Culture and society always an important factor that contributed to build thestereo types rather positive and negative that affect our everyday life. As with other social issuesageing is also effected the cultural and societal stereo types. Concept of old age was not theonly creation of old age rather it was started when they were young and strong concepts weredeveloped and concreted with the passage of time as he get older and older. Objective: (1) Toexplore what Older Persons (OPs) perceived about old age. (2) To find the cross relationshipbetween their concept of old age and their disease status. Methodology: Statistically calculatedsample of 384 OPs were randomly interviewed by taking their verbal consent after introducingthem about objective of study. Structured questionnaire was developed for data collectionpurposes. Data was entered and analyzed in SPSS. Results: among 384 respondents 31.3%perceived old age as illness and disease, 15.9% consider it stress and depression, 25.5% wereof the view that old age is phase of social isolation and ignorance, increased dependencywas also recorded 9.1% and less social participation as 11.7%. Hypertension was reportedby 8.1% of the study respondents, Heart problem in 12.8% cases and Diabetes in 15.1%cases. Conclusion: Awareness of religious education along with role of social institution playsthe leading role to reduce the intensity of negative stereo types and helps elders to developpositive concepts about their last age will be supplementary measure for active, and healthyand prosperous old age.

Older age is defined as "the phase of life when someone is socially, economically and culturally dependent on others to pass their life". Loneliness is an important concerns' of researchers especially to study its damaging effects on older persons. Pakistan with 6 th largest population of the world facing ageing issues as other nations of rest of the world. Objectives: To explore the existence of loneliness and its effects on elder's health as observed by their disease status. Design: Cross sectional study. Period: Sep 2013 to Dec 2013. Setting: TMA Rawal Town, TMA Potohar Town, Rawalpindi City. Methodology: Research was conducted in urban areas of Rawalpindi city and to collect the data a structured data collection tool was developed and modified with the help of pre-test observation under similar urban environment. After data collection tool responses were converted into code plan and then data was entered in EpiData and analyzed in SPSS. Results: These show the participation of males about 70% and females 30%. Among 384 respondents, 88.3% reported feelings of loneliness and only 11.7% not agreed with the question statement. Cross comparison of loneliness and disease occurrence shows that those OPs who feel loneliness predominantly reported the diseases like Hypertension, Heart problems, Diabetes, Arthritis, Asthma and TB etc. These findings depicts that loneliness played a key role in the promotion of bad health status among OPs of sample area. Conclusions: Legislative bodies should consider this issue and do practiced efforts to increase OPs participation within a family and their immediate social networks, it will help to reduce bad effects of loneliness and sustain active ageing.

Background: The Older Persons (OPs) are the knowledge and experiencebanks who hand over their life experiences to run society to the youth to further take up thesociety for the continuity of life and its progressive upward mobility. Objective: The aim of studywas to explore the interrelationship of older persons’ health care and social protection in thelight of United Nations Principles for Older Persons in Rawalpindi city. Study Design: CrossSectional Study. Materials and Methods: Structured questionnaire was developed to collectinformation on Older Persons’ health, economic and psychological status. In this regard, anextensive questionnaire was designed and pre-tested vigorously. Place & Duration of Study:The data collection was done in various union councils of Rawalpindi city. The study durationwas three months and lasted from September 2013 to December 2013. Results: Family isconcerned about the welfare of OPs but the financial liabilities. In 82.8% cases children werefound to be caring whereas in 17.2% cases kids were totally forgetful. 46% OPs were primarilynursed by their spouses and 34% by sons or daughters. 44.3% OPs still managed their financialaffairs. In 66% case no secondary financial facility was provided by the government. 28.9%cases were those where OPs requested help from other sources. Conclusions: The IslamicJurisprudence, Constitution of Islamic Republic of Pakistan and UN Principles demand thegovernments and states to intervene in the situation and make sure that the OPs are enjoyingequal access to independence, (social) participation, care, self-fulfillment and dignity.

Background: The presence of a mass in the nasal cavity and paranasal sinusesmay seem to be simple problem, but it is very difficult to differentiate clinically from potentiallymalignant tumors. Objective: To evaluate the clinical presentation and histopathologicalfeatures of the non malignant lesions of nasal cavity and paranasal sinuses. Study Design:Prospective descriptive study. Place and duration of study: Study was carried out indepartments of Paediatrics and ENT at Ghulam Muhammad Mahar Medical College HospitalSukkur from Jan 2009 to Dec 2012. Patients and Methods: The study included all cases of nonmalignantmasses of nasal cavity and paranasal sinuses, those attended the Paediatric & ENTdepartment and underwent the surgical intervention. One hundred twenty non-malignant caseswere enrolled for this study. A separate pro-forma was filled to record the cases biodata, history,clinical examination, investigations and histopathological diagnosis. All histopathologicallyproven malignant masses were excluded from the study. Results: Out of 120 cases 78 (65%)were males and 42 (35%) were females, with M:F ratio of 1.8:1. The age of presentation rangedfrom 8 years to 70 years and mean age was 26.3years. Sinonasal masses were found to bebilateral in 20 cases (16.67%), right sided in 65 (54.17%) and left sided in 35 (29.16%) cases. Themain presenting symptoms were nasal blockage 110 (91.66%), nasal discharge 102 (85%),sneezing 60 (50%), hypoinsomnia 36 (30%), epistaxis 24 (20%), headache 20 (18.33%) andmouth breathing 18 (15%) cases. Polyp was the most common lesion in 86 (71.66%) casesobserved in this study. The common histopathological diagnosis was simple inflammatory nasalpolyp in 48 (40%), allergic nasal polyps 30 (25%) and fibroepithelial polyp in 8 (6.7%), invertedpapilloma in 12 (10%), angiofibroma 6 (5%), capillary hemangioma 4 (3.34%) andrhinosporidiosis 4 (3.34%) cases. Conclusions: Sinonasal masses have various differentialdiagnoses and are still thought to be simple problem in our society. There is a need for earlyrecognition and referral to ENT surgeon and need histopathological examination of every massto confirm the diagnosis.

Every day, 25–30 new cases of dog bites are treated at the civil hospital in Karachi. In absence of accurate number of rabiesdeaths, Infectious Disease Society of Pakistan suggests there are around 2000–5000 rabies deaths per year2. The estimated prevalence ofdog bites in Punjab is 0.03%, but no such estimate is available for Lahore3. Objective & Method: A community-based survey was carried out toassess the burden, determinants and public services available for dog bites in Lahore district, Pakistan. Results & Discussion: Theprevalence of dog bites in the study population was 21.3%. The most common site of bites was the legs (68.4%), followed by the abdomen ortrunk (12.1%), and hands or arms (5.6%). Among respondents to an exit interview administered to clients seeking care from an antirabiescentre, the most frequent age group of victims of dog bites was 16–60 years (53.4%). The majority of respondents had been bitten by stray dogs(63), while 47 respondents were bitten by their own or others’ pet dogs. Six respondents reported bites from rabid dogs. One hundred andseven (107) respondents said they had received vaccination at dog-bite centres; 89% of respondents confirmed the availability of vaccine,while 74.1% respondents said that they did not pay fees for services. Conclusions: The life-time prevalence of dog bites among respondentswas 21.3%. The most frequent age group of victims of dog bites was 16–60 years. Both stray and pet dogs had bitten the victims.

Objective: An inadequate closure of the appendix stump leads to intra-abdominal surgical site infection. Many studies show that the use of costly high tech instruments such as Endo-loops, Endo-GIA for transaction and closure of the appendiceal stump lowers the risk of infection. The Aim of this study was to evaluate the use of clips for closure of appendix stump as a safe and cost-effective method. Study Design: Descriptive Study. Period: Oct 2009 to Jun 2010. Setting: Shalamar Hospital, Lahore. Materials and Methods: Over a period of 9 months 36 patients were selected to have laparoscopic appendicectomy. All patients had stump closure by clips as used for cystic duct and cystic artery in laparoscopic cholecystectomy. No patient had Endo-loop or Endo-GIA for closure of stump. All patients had follow-up at one week and six weeks after discharge from hospital. Results: There was no clinical evidence of surgical site infection or leak from appendicular stump by this method. There was no discomfort in handling this instrument both for surgeon and scrub nurse. The price of the clips used was 4.30 Euros as compared to 112.00 and 232.77 Euros for the Endo-loops and Endo-GIA respectively. Conclusions: This study shows that clips can be used for stump closure without any additional risk to patient. It is also cost- effective. So appendiceal stump closure using clips is very convenient, an easy, safe, and cost-effective procedure.

Background: The first merging of small hospitals into a large one came into existence in January 2005 in county Louth. As a result the surgical departments of Louth county hospital Dundalk and Our lady of Lourdes hospital Drogheda Ireland were combined. Two hospitals are at less than half an hour drive and situated North-eastern region of Ireland. Objectives: To assess the impact of joining two departments of surgery in two different hospitals along with the patient’s reaction after such arrangements were made. Design: review of literature. Setting: Louth County Hospital Dundalk Ireland. Period: One year Methods: Following review of literature it was decided to explore the experience of patients who were treated in Louth County Hospital Dundalk one year after merging of two departments of surgery. Randomly 20% of patients treated in Louth County Hospital were included in a telephone survey. These patients were under care of all consultant surgeons. The patients were asked about their experience in Louth hospital. Also impact of joining surgical departments on waiting list was explored. Results: Out of 1310 patients, 20 % of patients treated in Louth Hospitals were included in the survey. The age of the patients varied from 15 to 67 years. 57 % of the patients were female and the remainders were males. It was found that 93.5% of patients were happy to travel to Dundalk and 96.5% were satisfied with the facilities there as well. Furthermore 96% said that they would be happy to have surgery in Dundalk if they ever needed it in the future. 6% of patients were dissatisfied with services in Louth County Hospital, Dundalk. Conclusions: The improvement of quality processes in healthcare is of constant concern to communities throughout the world. The results have clearly demonstrated that restructuring of services can work well and be acceptable to patients once hospitals are prepared with relevant resources in place.