Anum Usman, Noor Khan Lakhnana and Humaira Zafar
Al Nafees Medical College & Hospital, Islamabad

Abstract: Endometrial stromal sarcoma is an unusual malignant neoplasm of the uterus. It mainly occurs in the age of 40–50 years. It accounts 2 to 6% of uterine malignancies. Usually, the diagnosis is confirmed postoperatively. Common symptoms are abnormal vaginal bleeding, abdominal mass and mild abdominal pain. We report a case of endometrial stromal sarcoma in a 40 years old woman. Biopsy specimens were received at the pathology lab of ANMCH. She presented with abnormal vaginal bleeding since 4 months. Histopathological findings confirmed the diagnosis of endometrial stromal sarcoma which was then confirmed on immunohistochemistry. We aimed to present a case of endometrial stromal sarcoma because of its rare occurrence and problems in establishing histopathological diagnosis
Key Words: Endometrial stromal sarcoma, Uterine malignancy

Institutions are made from people and not from bricks and cements. Even single great individual can change the course of the history. Divine guidance had been documented to bring fundamental changes! The best and the most authentic evidence comes from the example of the final Prophet Muhammad ﷺ whose influence is not only well documented but also well recognized even by learned non Muslims! Michael Hart’s book on 100 most influential people therefore rank him # 1 in the list. The seeds of human development which was sown in his life time through final divine book Quran and his wise, honest and dedicated explanation of the Quran through deeds and words brought the big bang in the universe of science. This can be seen in the 8 most glittering centuries of human history i.e. 600-1400.  Imam Malik; a single individual teacher at Great Masjid (mosque) of the Prophet ﷺ in Madinah Munawwarah  produced such great patrons of sciences as Ma’moon Rashid who nurtured, patronized and supervised the great culture of scientific work. Famous Muslim conquerers such as Slahuddin Ayyubi and Mehmood Ghaznawi are known for their bravery and great war abilities but most people are unaware about their great contributions as most generous patrons of sci

Muhammad Habeel Dar1, Sohail2, Yasir Adnan3, Lubna Noor4 and Mohammad Hafizullah5
Department of Cardiology, Lady Reading Hospital, PGMI, Peshawar, Pakistan

ABSTRACT
Objectives: This study was designed to find out the Frequency of new onset atrial fibrillation in patients with acute myocardial infarction having HIGH CHADS2 SCORE.
Material and Methods: This was a Cross Sectional Descriptive study. The study was carried out at the Department of Cardiology, Lady Reading Hospital Peshawar From 7th March to 6th September 2014. All Patients with acute myocardial infarction having CHADS2 SCORE 3 and above were enrolled. Patients were monitored for AF during their total hospital stay. Study end point was new onset atrial fibrillation that last for more than 30 seconds. Data analysis was done using SPSS version 16.
Results: We enrolled 186 patients of acute myocardial infarction patients having CHADS2 SCORE three or more at admission. The mean age was 56.55 years + 13.992SD years. Out of 186, 99(53.23%) were male and 87(46.77%) were female patients. Over all new onset atrial fibrillation was observed in 40(21.51%) patients having acute myocardial infarction patients with High CHADS2 SCORE while 146(78.49%) have not faced the new onset atrial fibrillation during the study period. About 20(23%) female patients presented with acute myocardial infarction patients having High CHADS2 SCORE, developed new onset atrial fibrillation as compared to 20(20.2%) male patients who developed new onset atrial fibrillation. However, this difference was statistically not significant. Conclusion: Atrial fibrillation is one of the most common heart rhythm disorders, with a prevalence that is on the rise. Risk factors for the development of AF are very similar to those for developing coronary artery disease. AF is often associated with acute myocardial infarction in patients with High CHADS2 SCORE. Emphasis should be given on prevention, early detection and immediate management of atrial fibrillation in patients of acute myocardial infarction having High CHADS2 SCORE.
Key Words: Atrial Fibrillation, Acute Myocardial infarction, CHADS2 SCORE.

Muhammad Mateen Khan¹, Abdul Khalid Awan², Raja Muhammad Arif Khan³, Naveed Ahmed², Wafa Hussain⁴ and Muhammad Asif Khan⁵

¹Azad Jammu & Kashmir Medical College, Muzaffarabad ²Abbas Institute of Medical Sciences, Muzaffarabad

³ Department of Education, Govt. of AJK, Muzaffarabad, ⁴Central Blood Transfusion Services, Muzaffarabad, ⁵Agricultural Department, Govt. of Azad Jammu & Kashmir, Muzaffarabad^.

ABSTRACT

Objectives: Prevalence of malnutrition in AJK is very high in children between the age of 5-14 years and research based information about these health problems are generally lacking in school going children. The purpose of the present study was to find out the relationship between malnutrition and worm infestation in school going children.

Methodology: The study was carried out in Abbas Institute of Medical Sciences (AIMS) Muzaffarabad. Total 1902 students from nine Government schools of Muzaffarabad of age 5-14 were examined. Among these, 200 children were found with 3rd degree malnourished excluding children who were suffering from chronic diseases. Weight and height of the students was recorded. Stool samples of the students were collected and examined within one hour of collection under direct light microscope.

Results: Among these 200 students, 130 (65%) were found to have ova of one or more types of worms. Among the total population 190(10%) were having worm infestation. The male and female ratio for positive stool test was almost equal. Ova of the seven different types of worms were found in stool of infested students. By for the most common was Tenea (21%) and H-Nana (20%) species. Other species found were Hook worm (20%), Ascaris lumbricoides (12%), Trichoris Tricura (11%), Enterobius Vermicularis (10%) and Giardia Lamblia (6%). The relationship between worm infestation and malnutrition was found highly significant (p<.001). Among malnourished students, 65% were having worm infestation whereas only 6% of well-nourished children have worm infestation. The results pertaining to socio-economic status and malnutrition pointed out that the student having low socio economic status were more malnourished (96%) as compare to upper class (4%) p<.001. The relationship between malnutrition and safe water supply highlighted  that the student having safe water supply were less malnourished (p<.001). Among the infested students, 84% falls under the category that depends on open field excreta disposal.

Conclusions: Prevalence of worm infestation was quite high in severely malnourished school going children and the most common worm infestation in our study was Tenea Saginata and H-Nana.

Keywords: Gomeze classification, worm infestation.

Ruqqayya Ishaq, Henna Azmat, Maria Omair, Ahmareen Khalid Sheikh and Ashok Kumar Tanwani
Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad Shaheed Zulfiqar Ali Bhutto Medical UniversityPakistan

Abstract: Fine Needle Aspiration Cytology (FNAC) is a useful diagnostic aid in benign and malignant lesions. The diagnostic accuracy of FNAC depends on the sampling technique, fixative used, quality of staining and of course the meticulosity of interpretation by the pathologist. The widely used fixative in this procedure is 95 % Alcohol which although readily available, has a number of limitations for use. It is expensive and hence subject to pilferage. Also, it is a volatile liquid with an irritant smell and is said to be carcinogenic. Recent attempts have been made to prove that honey is also a comparable fixative for cytological specimens. It is a natural organic product, odourless and not known to cause any disease. Secondly it is relatively cheaper and not prone to be mishandled, making it an efficient contender for use as a fixative. In this study, we analyzed and compared the efficacy of cytological smears fixed in 95% alcohol and 20% honey solution. The results of our study showed no statistical significant difference in the fixative properties of honey and alcohol. Our results, therefore, confirmed that honey can safely be used as an alternate to alcohol in cytology specimens.
Key words: Honey, alcohol, Fixative, Fine Needle Aspiration Cytology, FNAC

Muhammad Farooq
Department of ENT Azad Jammu and Kashmir Medical College Muzaffarabad

Abstract: Presently Septoplasty is being performed as admitted case by most of Otorhinolaryngologists and anterior nasal packaging is applied for about 24 hours, which is not free of complications.
Objective: To study the significance of early (after about 4 hours) removal of nasal packing after Septoplasty and its feasibility as daycare surgery.
Patients and Methods: This was a prospective and experimental study conducted on 100 patients for 18 months, who were operated for symptomatic deflected nasal septum (DNS). Patients were randomly divided into two equal groups. In Group-A admitted patients, after septoplasty nasal packing was removed after 24 hours and in Group-B after septoplasty, it was removed after about 4 hours; allowing patients to go home after 5-6 hours. Patient’s discomfort caused by nasal packing was evaluated by means of a visual analog scale from zero to 10. Post-operative complications of septoplasty were also compared in both groups.
Results: Patients discomfort score due to nasal packing and complications of septoplasty were found significantly less in Group-B as compared to Group-A.
Conclusion: Early removal (after about 4 hours) of nasal packing following septoplasty was more comfortable and beneficial as compared to removal of nasal packing after 24 hours. It also made septoplasty a day care, more cost effective and convenient operation.
Key Words: Deflected nasal septum, Septoplasty, duration of nasal packing, trans-septal suturing, nasal discomfort score, complications, nasal splints, daycare surgery.

Kausar Rehana and Muhammad Mudassir Shafiq
Department of Pulmonology, Pakistan Institute of Medical Sciences Islamabad

Abstract: Ewing sarcoma is a malignant small round blue cell peripheral primitive neuroectodermal tumor (PNET). Its most common location is flat bones including pelvic bones, ribs and clavicle. It does however occasionally occur in femur and humerus. Rarely Ewing’s sarcoma occurs in soft tissues known as Extraskeletal Ewing’s sarcoma. A large Ewing sarcoma arising in the chest from rib or vertebral column is known as a skin tumor! We report a case of a 10-year-old girl who presented with right sided lung mass. Radiology, histopathology and immunohistochemistry confirmed the diagnosis of Ewing’s sarcoma. Our case highlights the fact that Ewings sarcoma/PNET should be considered in differential diagnosis of patients presenting with lung mass.
Keywords: Ewing’s sarcoma, Ewing’s sarcoma, Extraskeletal Ewing’s sarcoma, small blue cell tumor, Primitive Neuroectodermal tumor, PNET

*Shawana Sharif and **Anwar-Ul-Haque
*Department of Dermatology Benazir Bhutto Hospital, Rawalpindi Medical College, Rawalpindi, **Department of
Pathology Azad Jammu & Kashmir Medical College, Muzaffarabad, Azad Kashmir

Abstract: Alkaptonuria is a rare metabolic disorder caused by deficiency of homogentisate dioxygenase; which leads to deposition of homogentisic acid which gets deposited in connective tissue as a melanin like pigment. We had a female patient who presented to us with abnormal pigmentation on her face and hands which was not cosmetically acceptable to her. Upon exploring, she had a history of darkening of urine. Her skin biopsy demonstrated fragmented collagen and deposits of pigment in connective tissue. Subsequently she was found to have high levels of homogentisic acid in urine. We recommend that every case of abnormal hyperpigmentation should be looked for the possibility of alkaptonuria.
Key Words: Alkaptonuria, Pigmentation, Ochronosis