These are two case reports of females with primary amenorrhea, well developed secondary sexual characteristics and congenital absence of uterus. The incidence of Mayer-Rokitansky-Kuester-Hauser syndrome was not clearly established, but studies indicate a variation of 1/4,000 and 1/5,000 live births of the female sex. The syndrome is characterized by aplasia of the Müllerian duct (uterus and upper two-thirds of the vagina) on a person who has karyotype 46, XX with female phenotype characteristic of primary amenorrhea in adolescence. Treatment is usually delayed until the patient is ready to begin sexual activity.

Background: Staphylococcus aureus is important cause of blood stream infections. The objectives of this study were to determine the frequency of Staphylococcus aureus in blood stream infections and their antimicrobial drug susceptibility pattern. Materials & Methods: This cross-sectional study was conducted at the Department of Pathology, Shaikh Zayed Hospital, Lahore from April 2018 to March 2019. The sample size was 1527 positive blood cultures for bacteria selected through consecutive sampling technique. Research variables were; presence of positive blood cultures, presence of staphylococci in positive blood cultures, types of staphylococci and types of staphylococcus aereus. Frequency and percentage of blood stream infection caused by Staphylococcus aureus and susceptibility of Staphylococcus aureus to various antimicrobial drugs was detected by disc diffusion and e-strip method. Results: Out of 12744 blood cultures, 1527(11.98%) were positive for bacteria. Out of these 1527, 339(22.20%) were positive for staphylococci. Out of these 339, 87 (5.69%) were staphylococcus aureus. Out of these 87, 48 (3.14%) were methicillin resistant (MRSA). Susceptibility of S. aureus isolates to various commonly used drugs was also detected. Conclusion: Staphylococcus aureus is a significant cause of blood stream infection and can exhibit multi-drug resistance. Therefore drug susceptibility profile of pathogens prevalent in hospital should be monitored and kept in mind when prescribing antimicrobial drugs before getting results of antimicrobial drug susceptibility tests.

Background: Malnutrition continues to be a major public health problem in developing and underdeveloped countries. The objectives of the study were to determine the determinants of nutritional status of under 5 years children in our population. Materials & Methods: This analytical cross sectional study was conducted by the Department of Public Health, Islamabad, Federal College, Islamabad, from November 2016 to March 2017. Sample size was 200 selected by convenient sampling. Demographic variables were sex, age-groups, socio-economics status, family structure. Research variable was nutritional status. The data collection was done in urban slums of Islamabad on a structured questionnaire. Statistical analysis was done by using SPSS software. Results: Out of 200 children, 117(58.5%) were boys and 83(41.5 %) were girls. One hundred (50%) children were of 6 to 24 months and 100(50%) were of 25 to 59 months of age. Eighty three (41.5%) were rich and 117(58.5%) were poor. One hundred and fifty eight (79%) children were from joint family system and 42(21%) were living in nuclear family system were children. One hundred and fifty one (75.50%) were normal, 39(19.50%) were mild and 10(5%) were having severe malnutrition. Conclusion: Except age all the other factors including sex, socio-economics status and family structure were associated with nutritional status of under 5 year children.

Dengue fever (DF) is a viral disease transmitted by Aedes aegypti and Aedes albopictus mosquitoes. Dengue virus (DENV) has four subtypes or serotypes i.e. DENV-1, DEVNV-2, DENV-3, and DENV-4.1,2 The incubation period is 3 to 14 days. Infection with one subtype confers life-long immunity to that type only. However, infection to other serotype in future may result in more severe disease with increased chances of serious complications.1 The disease affects some 50-100 million people worldwide every year. Out of whom about 1-2% patients develop its serious complications like dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), resulting in about 22,000 deaths per year. Dengue fever (DF) is endemic in all the regions of Pakistan and 3204 confirmed cases of dengue fever were reported during 2018.3-5 Pakistan has seen dengue epidemics in the past and such epidemics are always apprehended from August to October every year because of favourable seasonal conditions for its vector to flourish. Dengue epidemics are really like a nightmare and timely measures against the culprit mosquitoes is the only way to avoid these epidemics. The Field Epidemiology & Disease Surveillance Division of Ministry of National Health Services, Regulations & Coordination has issued an advisory for the prevention and control of Dengue fever, has timely issued the guidelines for the year 2019.3,6,7 Early identification and good clinical management are important to reduce its mortality.3 A study from D.I.Khan of Khyber Pukhtunkhwa province has shown that knowledge regarding the DF is low and the public needs to be educated about dengue disease and its prevention utilizing all the sources of information employing mass media, print as well as electronic.3,8 The health departments of both the Federal and Provincial Governments are leaving no stone unturned to increase the public awareness. The academia is also motivated to have research and write on this topic to further enhance the knowledge so that we see the preventive efforts in the practice among the masses.

Background: The proper use of spinal anesthesia in surgical procedures will minimize patient’s referral. The objectives of the study were to determine the immediate and late complications of spinal anesthesia in obstetric and gynecological surgical procedures in our population. Material and Methods: This cross-sectional study was conducted in the Department of Gynecology and Obstetrics, Moulvi Ameer Shah Memorial Hospital, Peshawar, Pakistan from January 2014 to December 2014. Sample size was 790, selected through consecutive sampling technique. All routine and emergency obstetrical and gynecological cases were included. The exclusion criteria were those having hypotension, shock, coagulopathy, prolonged surgeries, patient’s refusal and local spinal disease. The demographic variables were; number of attempts, failure of anesthesia, vomiting, hypotension, respiratory problems, pain, Puncture site pain, and post dural puncture headache. All variables being categorical were analyzed by frequency and percentages using SPSS Version 16.0. Results: Out of 790 obstetrics and gynecology patients undergoing spinal anesthesia, there were 752 (95.2%) patients anaesthetized on first attempt whereas 38 (4.8%) required >1 attempts. Spinal anesthesia failed in 17 (2.1%) cases, partially failed in 15(1.9%). Post-operative mild hypotension was observed in 25 (3.1%) patients and severe hypotension in 4 (0.5%) cases. Respiratory problems were noted among 12 (1.9%). Patient’s Post-operative pain was observed in 28 (3.5%) patients. Nausea and vomiting were noted in 68 patients (8.6%).Late complications include post-operative mild to moderate pain in 65 (8.2%), severe in 15 (1.9%). Puncture site pain was observed in 8 (1.0%) of patients. Severe post dural puncture headache was noted in 3 (.38%). Conclusion: Spinal anesthesia in obstetric and gynecological surgical patients is easy to administer, safer and effective.

Background: Flexor tendons injuries are common emergency procedures The objectives of this study were to determine the frequency, distribution and results of treatment of acute flexor tendon injuries in zone V of hand in our population. Material and Methods: This descriptive cross-sectional was conducted in the Department of Orthopedic, Gomal Medical College, D.I.Khan, Pakistan from January 2015 to December 2017. Sample size was 30, selected through consecutive technique. Patients having flexor tendon injuries in zone v, admitted through emergency department were included in this study. Demographic variable were sex and age-groups. The research variable were tendon involved, nerves involved, artery involved, mechanism of injury, wound size, duration of injury, season, type of injury, hand involved and results of treatment. All variables, being categorical were analyzed by frequency and percentages using SPSS version 16.0. Results: Out of 30 patients, 22(73.33%) were male. Twenty four (80%) patients were between 21 to 40 years age. Mechanism of injury was glass in 16(53.33%) cases, knife in 10(33.33%) cases. Twenty (66.66%) cases presented in summer. Flexor digitorum sublimus was injured in 21(70.0%), FCR in 11(36.66%), FPL in 8(26.66), FDP in 6(20.0%) and FCU in 4(13.33%) cases. Median nerve was involved in nine (30%) cases. Radial artery was involved in eight (26.66%) cases. Wound size was 2 cm in 24(80%) cases. Sixteen (53.33 %) cases came with self-inflicted injuries. Twenty (66.66 %) cases came after 12 hours. Twenty five (83.33%) patients achieved good to excellent results. Conclusion: Flexor digitorus sublimus was the most common tendon injured in non-dominant hand, especially in young males. Median nerve and radial artery were commonly injured structures mostly with glass. Majority patients presented more than 12 hours after injury, having wound size of 2cm. Mostly the injuries were self-inflicted and occurred in summer season.

Background: In developing countries, miscarriage is one of the common and increasing problems of pregnancy. The objectives of this study were to determine the frequency of pre-gestational diabetes mellitus among pregnant women with miscarriage in our population. Materials & Methods: This descriptive, cross-sectional study was conducted in the Department of Gynecology and Obstetrics, Khyber Teaching Hospital, Peshawar, Pakistan from 3rd November 2015 to 2nd May 2016. Sample size was 268 pregnant women with miscarriage selected through consecutive sampling technique. Inclusion criteria were all pregnant women with miscarriage. Exclusion criteria were molar pregnancy, ectopic pregnancy and diabetics. HbA1c levels of =6% was taken as normal, whereas a level >6 was taken as raised level or pre-gestational diabetes. Variables were age, pre-gestational diabetes mellitus, number of pregnancies and duration of pregnancy (=24, >24). Mean and SD were calculated for quantitative while frequency and percentages for qualitative variables. Descriptive analysis was performed by using SPSS version 16. Results: Mean age of the patients was 27.66 ±4.93 years. Out of 268 participants, 81(30.22%) were having pre-gestational diabetes mellitus and 187(69.78) were normal, 234(87.31%) were having first pregnancy whereas 34 were having >1 pregnancies, the pre-gestational age = 24 weeks were 130(48.51%) and >24 weeks were 138(51.49%). Conclusion: One third of the patients with miscarriage were having pre-gestational diabetes mellitus. Almost half of the patients were having gestational age of <24 weeks.

This 7 years old male child is a case of collodion baby who goes to school. He is having high hypermetropia with esotropia and bilateral lower lid ectropions. He has got a younger sister of four years age with similar problem whereas another brother is quite normal. His parents are first cousins to each other, showing genetic predilection of this un-common congenital disorder. He needs regular skin massage with Vaseline thrice a day. Such patients are more prone to dehydration and infections.

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