A young lady presented with history of giddiness, blackouts, and darkness of her skin colour especially the face. On examination the colour of her skin was quite dark but not much darker than her spouse. She had buccal pigmentations and her palmar creases were obviously pigmented. Facility for short Synacthen test was not available. Her serum cortisol was on the lower normal side and ACTH was sky high; 1024 pg/ml (ref. range adults: 6-76 pg/ml). She was screened for ectopic ACTH production which could not reveal any pathology. Also plain abdominal x-ray didn’t show any adrenal calcification. She was labeled as Addison’s disease and improved drastically after replacement therapy (Cortisone + Fludrocortisone). Giddiness aloof, she was delighted with the fairness of her colour.

Thirty five years old women presented to the Accident and Emergency Department with acute onset right upper quadrant abdominal pain with normal vitals. CT images revealed a malrotation causing midgut volvulus and intestinal obstruction. On emergency exploratory laparotomy, the gut loops showed partial ischemia due to a double twist at the root of mesentery and malrotation of the gut along with the caecum which was mobile coming from left iliac fossa and lying in the right iliac fossa. Duodeno-jejunal junction was identified. The coils of the intestine were untwisted and rotation was corrected. The gut color changed back to normal. She was discharged painless after routine post-operative care.

Cervical cancer is a malignant neoplasm of the cervical area or cervix which may present with the vaginal bleeding but symptoms may be absent until the cancer gets in advanced stage. Dysplasia seen on cervical biopsy uses the term cervical intraepithelial neoplasia (CIN) and is grouped into mild (CIN-1), moderate (CIN-2) and severe (CIN-3). The severity of CIN depends upon cellular disorganization, cellular immaturity, increased mitotic activity and nuclear abnormalities. The nuclear atypia, extent of mitotic activity and immature cellular proliferations identifies the degree of dysplasia. Thus, epithelial thickness which shows differentiation is the useful feature in decision about severity of CIN. Treatment of this cancer may be ablative and/ or excision. Cryotherapy is a reasonable treatment of CIN-1 and CIN-2 but not of CIN-3 which is severe cervical carcinoma. Burning the TZ-transformation zone (Electro diathermy) destroys the tissue more effectively than that of cryotherapy but it usually requires general anesthesia, however laser cold coagulations technique requires local anesthesia usually. Laser TZ Excision compromises the fertility. Knife cone biopsy is used as a preferred treatment for removal of abnormal cervical cells. Now the cone biopsy is generally performed using the laser surgery. Early diagnosis of cervical cancer is very necessary for better control and treatment of it. For early phases of cervical carcinoma, the cryotherapy is very reasonable, however in case of late stage of the disease laser methods are used alone or on combination. Therapy will be termed successful if cytology remains negative after at least six months of its treatment.

Being signatory to Alma Ata declaration, the Government of Pakistan started the ‘National Program for Family Planning and Primary Health Care’ (NPFP & PHC), also called ‘Lady Health Workers (LHWs) program’ in 1994. Being one of the largest and successful, community-based program in the world, it is providing door-step PHC services to about one billion people, especially home-bound, rural, poor women, children and elderly. The program has been improving many health indicators including infant and maternal mortality rates in the last two & a half decades.

Background: Snake bite remains major public health problems worldwide. The objective of this study was to determine predictors of in-hospital mortality in patients presenting with snake bite in population of Karachi, Pakistan. Materials & Methods: It was cross-sectional study conducted at Department of General Medicine, Postgraduate Medical Center, Karachi, Pakistan from 11th June 2016 to 10th August 2017. 300 patients with snake bite were selected. Age, gender, acute kidney injury, vomiting and in-hospital mortality were variables. Except age, all variables were nominal and were analyzed by frequency and percentage. Cox-proportional-hazard regression model was applied and hazard ratios were calculated along with 95% confidence intervals (CI) to assess the strength of association between predictors i.e. age, gender, AKI and vomiting and outcome (in-hospital mortality). Kaplan-Meier and time to event plot were used to investigate all patients who were on follow-up for 7 days from admission. Log-rank test was used to identify the predictors of in-hospital mortality for significant independent influence on prognosis at alpha .05. Results: The mean age of the sample was 27.7±14.58 years. Out of a sample of 300 patients, 221 (73.7%) were males and 79 (26.3%) females. The frequency (%) of AKI was 102 (66%), vomiting 122 (40.7%) and of in-hospital mortality 31 (10.3%). The probability of survival at day 7 was 81.8%. Vomiting [hazard ratio 6.86 (95% CI: 2.78-16.93), p=<0.001] and acute kidney injury [hazard ratio 3.85 (95% CI: 1.75-8.45), p=<0.001] were associated with higher risk of death in adjusted analysis. Conclusion: Acute kidney injury and vomiting are strong predictors of mortality among patients with snake bite. These predictors can be helpful for clinicians in assessing prognosis of their patients more accurately and by early management of these factors, mortality & morbidity can be reduced.

Background: Literature has reported thyroid functional abnormalities in diabetes mellitus. The objectives of this study were to determine and compare the serum concentrations of T3, T4 and TSH in alloxan-induced type 1 diabetic and control Wistar albino rats. Materials & Methods: It was an experimental animal study on 20 Wistar albino rats, extending over a period of eight weeks. Alloxan, a diabetogenic agent, was used to produce animal models of type 1 diabetes. Animals were divided equally into two groups: control and diabetic. The animals in the diabetic group were injected intraperitoneally with 150 mg/kg body weight of 10% alloxan to induce diabetes. After 72 hours, diabetes was confirmed with glucometer (glucose >350mg/dl). During the course of experiment, one rat in control group and 2 rats in diabetic group died. Blood was collected for estimation of serum concentrations of thyroid hormones, thyroid stimulating hormone at the end of experimental period. Serum T3, T4, and TSH were measured using ELISA kits. Results: At the end of eight weeks, the mean concentration of serum T3 was 0.69 ±0.29 ng/ml and 0.44±0.02 ng/ml in control and diabetic groups, respectively. The mean concentration of T4 was 3.78±1.16 µg/dl and 2.24±0.86 µg/dl in control and diabetic groups respectively. The mean concentration of TSH was 0.77±0.20 µU/ml and 1.41±0.23 µU/ml in control and diabetic groups respectively. The mean serum concentrations of T3 (p=.0025) and T4 (p=<.00001) were significantly lower in diabetic and that of TSH (p=<.00001) were significantly higher in diabetic than control group. Conclusion: This study concludes that the serum concentrations of both T3 and T4 are significantly lower and that of TSH is significantly higher in alloxan-induced type 1 diabetic as compared to control group in Wistar albino rats.

Background: Thrombophilia is a common risk factor for venous thromboembolism. The objective of this study was to determine prevalence of inherited protein C and protein S deficiency in renal transplant candidates of Sindh Province, Pakistan. Material & Methods: This cross-sectional study was conducted in Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan from 16-10-2010 to 15-4-2011. 300 renal transplant candidates were selected. Candidates with acquired thrombotic disorders, women taking oral contraceptives and patients taking anti-coagulants during previous one week were excluded. Venous blood samples were collected before starting dialysis procedure or at least two days after last dialysis session. Platelet-poor plasma (PPP) was parted using plastic pipettes and protein C and protein S were processed on coagulation analyzer. Sex, age groups (<40 and = 40years), presence of protein C deficiency and presence of protein S deficiency were nominal variables and analyzed by count and percentage along with population parameters. Results: 300 renal transplant candidates included 199 (66.33%) men and 101 (33.67%) women and 238 (79.33%) in age group <40 years and 62 (20.67%) cases in age group =40 years. Prevalence of protein C deficiency was 6.66% (20/300) and of protein S deficiency was 4% (12/300). Prevalence of PC deficiency was higher in men 5.33% than women 1.33%. Also prevalence of PS deficiency was higher in men 3.0% than women 1.0%. Prevalence of PC deficiency was higher in age group <40 years 5.67% than =40 years 1.0%. Also prevalence of PS deficiency was higher in age group <40 years 3.33% than =40 years 0.66%. Conclusion: More prolonged and follow-up studies are needed to define the true significance of deficiency of protein C and S (coagulation inhibitors) in post-transplant settings.

Background: Pediatric cataracts cause significant visual disability worldwide. The objectives of this study were to determine the distribution of pediatric cataracts by sex, age groups, laterality, type and presentation in population of D.I.Khan District, Pakistan. Materials & Methods: This descriptive study was carried out at Department of Ophthalmology, Gomal Medical College, D.I.Khan, Pakistan from January 2015 to December 2015. Sample was collected from Eye unit, DHQ Teaching Hospital, D.I.Khan. Pediatric cataract patients under 14 years of age were included in the study. Demographic variables were sex and age groups. Research variables were laterality, type and presentation. All variables being nominal were analyzed through frequency and percentages. The observed and expected distribution of pediatric cataract by sex, age groups, laterality, type and presentation were respectively tested by chi-square goodness of fit test. Results: Out of a sample of 47 patients, 29 (61.7%) were boys and 18 (38.3%) girls, 22 (46.81%) were <5 years and 25 (53.19%) 5-14 years of age. Thirty three (70.21%) had unilateral and 14 (29.79%) bilateral cataracts. Type was congenital/ developmental in 27 (57.45%) patients and traumatic in 20 (42.55%). Presentation was by defective vision in 23 (48.94%), leukocoria 14 (29.79%), strabismus 7 (14.89%) and screening in 3 (6.38%) cases. The observed distribution of pediatric cataract by sex (p=.0158), age groups (p=.00002), laterality (p=<.00001) and type (p=<.00001) was similar to expected, while for presentation, it was different than expected (p=.1033). Conclusion: The prevalence of pediatric cataract was higher for boys than girls and higher for older children (5-14 years) than younger (<5 years) children. Unilateral were more common than bilateral cataracts and the congenital/ developmental were more common than traumatic cataracts. Defective vision was the most common presentation of pediatric cataracts.

Background: Global Health Estimates 2015 has shown IHD as second leading global cause of death and 3rd leading global cause for DALYs for 2015. The objectives of this study were to determine frequency, distribution and determinants of DM in adult acute coronary syndrome (ACS) population of D.I.Khan Division, Pakistan. Materials & Methods: This cross-sectional study was conducted in Departments of Ophthalmology & Community Medicine, Gomal Medical College, D.I.Khan, from February 1, 2017 to April 30, 2017. 331 cases were selected with margin of error 4.511%, 90%CL and 25% prevalence of DM in 73,438 adults assumed to have IHD. All indoor adult patients of ACS were eligible. Sex, age groups, and residence and presence of DM were variables. Frequency and distribution were analyzed by count and percentage. Hypotheses for distribution were substantiated by chi-square goodness-of-fit and of association by chi-square test of association. Results: Out of 331 patients with ACS, 225 (68.0%) were men and 106 (32.0%) women, 221 (66.8%) =60 years and 110 (33.2%) >60 years, and 210 (63.4%) urban and 121 (35.6%) rural. Frequency of DM was 79/331 (23.87%). Out of 79 patients with DM, men were 44 (13.29%), women 35 (10.57%), age group =60 years 57 (17.22%), >60 years 22 (6.65%), urban 53 (16.01%) and rural 60 (7.85%). Our prevalence of DM was lower than expected (p=.00214), our distribution by sex was similar to expected (p=.4993) while our distribution for age groups (p=.01209) and residence (p=.00005) were not similar to expected. Presence of DM was associated to sex (p=.011) but not to age groups (p=.0304) and residence (p=.5241). Conclusion: Prevalence of DM in adult ACS population of D.I.Khan Division, Pakistan was found lower than expected. The prevalence was more in men than women, more in younger age group (=60 years) than older age group (>60 years) and more in urban than rural population. Our prevalence of DM was lower than expected, our distribution by sex was similar to expected while our distribution for age groups and residence were not similar to expected. The presence of DM was associated to sex but not to age groups and residence.