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To compare the role of paper-based versus digital record keeping in the orthopaedic ward in terms of staff satisfaction, education of staff, and adherence to British Orthopaedic Association (BOA) guidelines. Materials and methodsForty-four participants including nurses, senior house officers, foundation year trainees, and consultants completed a questionnaire. The first survey was done to introduce electronic records keeping to the participants and the second survey was conducted to review the collected record. Three parameters were assessed, which were adherence to BOA guidelines, staff satisfaction, and effect of education for both paperbased and electronic records. Comparison between two methods of record keeping was done by independent t-test for continuous data and chi-square test for categorical. ResultsFor all four questions about staff satisfaction, the score of the electronic method was higher than paperwork statistically. The score for 'opportunity to learn images in ward round' was higher in electronic (3.9±0.8) than paperwork (2.6±1.3) statistically (p<0.001). Comparable results were found for 'educational usefulness of ward round' and 'typing time affecting learning time'. For adherence to guidelines, the electronic record keeping was more effective in storing the patient's ID and name (p=0.05), details of documenting clinician (p<0.001), time of ward round ((p=0.005), whom to contact in case of concern (p=0.050), and grade of ward round clinician (<0.001). ConclusionElectronic records in the orthopaedic ward were deemed better than paperwork in terms of staff satisfaction, positive effect on the education of doctors, and adherence to BOA guidelines.

1Department of Medicine, 2Department of Orthopedics, Khyber Teaching Hospital, Peshawar-Pakistan Lofgren syndrome an acute form of sarcoidosis constitutes erythema nodosum, bilateral hilar adenopathy and arthralgia or arthritis. Here we present a case of a 28 years old young male patient who is a shopkeeper and farmer by profession admitted to inpatient department with chief complaints of bilateral painful nodules on his shins, low grade fever and pain multiple joints on both sides of the body. Suspicion of the Lofgren syndrome was made upon initial evaluation and patient was admitted to inpatient care facility for necessary comprehensive workup. Radiological findings were consistent with bilateral hilar lymphadenopathy and patient was diagnosed with Lofgren syndrome. Patient was started on non-steroidal inflammatory drugs (NSAIDs) with close observation for improvement in response to treatment. After one weak of treatment in hospital, patient was discharged home when his symptoms started to resolve.

ABSTRACT… Objectives: To note ultrasound findings in patient of Dengue Fever in pediatric age group and to find relation between ultrasonographic findings and severity of disease in terms decrease in platelets. Study Design: Cross sectional descriptive study. Setting: Department of Pediatric Khyber Teaching Hospital, Peshawar. Period: August 2017 to Dec 2017. Methodology: Data was collected randomly from 183 patients using pre designed questionnaire by interviewers for biodata, ultrasonography for radiological findings and analyzed by SPSS 21.0. Mean ± standard deviation was calculated for numerical variables like age where as for categorical variables frequency and percentage was calculated. Results: In the study 56.3% were males while 43.7% were recorded as females with mean age of 6.53 ± 3.40 Years. 18.6% showing anti-dengue serology (IgG & IgM) positive while 94.5% subjects showed positive NS-1, in other investigations 87% had thrombocytopenia in different categories with mild > moderate > severe. In the ultrasongraphic findings hepatomegaly and spleenomegaly shared maximum numbers of 28.4% while Ascites 23.5%, Pleural Effusion 7.1% & Gall Bladder thickness 7.1%. A P-Value of ≤0.05 was found when all these ultrasonographic findings were correlated with severity of disease in terms of decrease in numbers of platelets. Conclusion: DEN Virus is common most disease in our part of world. This study shows maximum number of patients with NS-1 shows hepatomegaly and spleenomegaly in ultrasonographic changes and the positive relation has been shown between decrease in platelets count with ultrasonographic findings.Article Citation: Zeb R, Ahmed MS, Zeb J. Dengue fever; ultrasonography of dengue fever patients in paediatric age group "a descriptive study at a tertiary care hospital Peshawar.

Background: Pneumonia is defined as inflammation of lung parenchyma. Aim of the current study was to identify the culture and sensitivity of bacteria causing pneumonia in one month to 5 years of age. Study Design: Cross sectional study. Setting: Department of Pediatric Medicine, Khyber Teaching Hospital (KTH), Peshawar. Period: December 2016 to March 2018. Material & Methods: Total 292 patients were randomly included in study. Data were collected by pre designed Performa and analyzed by SPSS 21. Results: Mean age of patients was 2.7 ± 1.2 years. Male to female ratio was 3:2. Culture report showed 123(42.1%) were Staphylococcus Aureus positive, 87(29.8%) streptococcus pneumonia, 75(25.7%) Hemophilus Influenza, 3(0.01%) Pseudomonas aeruginosa, 2(0.0068%) Klebsiella pneumoniae, 2 (0.0068%)  E.coli positive. All the bacteria were sensitive to commonly used antibiotics unless we observed resistance of H. Influenza against clarithromycin and Co amoxiclav. In rest of seven cases, out of total two cases of E. coli both were sensitive to amikacin while resistance to amoxil and co amoxiclave. Out of total three pseudomonas cases, two cases were resistance to ceftriaxone and amoxil, one was sensitive to ceftriaxone, while all three were sensitive to amikacin, two cases were of klebsiella pneumonia and both of them were sensitive to amikacin while resistant to amoxil. Conclusion: Most common organism causing pneumonia in one month to 5 years of age is S aureus followed by S pneaumoniae, H influenza, Paurogenosia, klabsiella and E.coli. Most of these organisms were sensitive to amoxil, ampiclox, cefotaxime and ceftriaxone while resistance of H influenza was observed to clarithromycin and co amoxiclave.

Objectives: To share our experience with laparoscopic surgery using TAPP technique, for groin hernias using light weight parietene mesh, to find out early post operative pain and foreign body sensation as complications. Study Design: Cross sectional study. Setting: Department of Surgery Khyber Teaching Hospital Peshawar. Period: January 2018 till August 2018. Material & Methods: A sample of 100 patients was recruited into study. All patients underwent standard transabdominal preperitonial repair with light weight Mesh. Data was collected by predesigned Performa and analyzed with SPSS 21. Results: Out of 100 patients 98% were male, 2% female, mean age was 43.2± 5.3years (minimum 17years and maximum 64years). Regarding frequency of type of hernia data showed 68% patients had indirect inguinal hernia while 32% patients had direct inguinal hernia. 65% patients had right sided inguinal hernia, 26% left sided while 9% had bilateral inguinal hernia. Post operative hospital stay showed hematoma in 5% patients, seroma in 12% patients, wound infection in 8% of patients while foreign body sensation in 4% patients. Conclusion: Most of the patients presented were of middle age. Indirect inguinal hernia was more frequent than direct inguinal hernia. Common complications apart from pain were seroma formation, hematoma, wound infection and foreign body sensation.

Objectives: To investigate infertility issues in Females and males due to sex hormones imbalance, Estimation of FSH, LH, Estradiol level in females infertile and Testosterone level in infertile males and females.Methodology: It was a cross sectional study conducted at reproductive physiology/health, public health laboratory division, national institute of health Islamabad from December 2015 to September 2017. Study was carried out on 60 male and 60 female infertile patients. FSH, LH, estradiole were estimated for females and testosterone for males by Immunoenzymatic assay (ELISA). Data was analyzed by SPSS 16.Results: Biochemical parameters for female population showed that 16.67% of sampled women indicated FSH level <4.5-11mIU/Ml while 40% with FSH level > 4.5-11mIU/Ml and 43.33% fall within normal range i.e., 4.5-11mIU/Ml. In the same manner, 10% of sampled female population was indicated with LH levels <2.12mlU/Ml, 36.57% with >10.89mlU/Ml and 53.33% within normal range i.e., 2.12-10.89mIU/Ml. Similarly, 30% women showed estradiol levels <40.7pg/ml while 16.67% were with >220.4pg/ml and 53.33% were found within normal range i.e., 40.7-220.4pg/ml. While the most common cause of male infertility by hormonal imbalance is due to either increased or decreased level of testosterone. 36.67% of sampled males indicated testosterone level less than normal i.e. <1.68ng/ml while 48.33% with testosterone level >7.81ng/ml and 15.00% fall within normal range i.e., 1.68-7.81ng/ml. Conclusion:We concluded from our study that the most common cause of female infertility by hormonal imbalance is due to either increased or decreased level of follicle stimulating hormone (FSH) followed by estradiole and leutinizing hormone (LH). While the most common cause of male infertility by hormonal imbalance is due to either increased or decreased level of testosterone.

Objectives: To note ultrasound findings in patient of Dengue Fever in pediatricage group and to find relation between ultrasonographic findings and severity of diseasein terms decrease in platelets. Study Design: Cross sectional descriptive study. Setting:Department of Pediatric Khyber Teaching Hospital, Peshawar. Period: August 2017 to Dec 2017.Methodology: Data was collected randomly from 183 patients using pre designed questionnaireby interviewers for biodata, ultrasonography for radiological findings and analyzed by SPSS21.0. Mean ± standard deviation was calculated for numerical variables like age where as forcategorical variables frequency and percentage was calculated. Results: In the study 56.3%were males while 43.7% were recorded as females with mean age of 6.53 ± 3.40 Years. 18.6%showing anti-dengue serology (IgG & IgM) positive while 94.5% subjects showed positive NS-1,in other investigations 87% had thrombocytopenia in different categories with mild > moderate> severe. In the ultrasongraphic findings hepatomegaly and spleenomegaly shared maximumnumbers of 28.4% while Ascites 23.5%, Pleural Effusion 7.1% & Gall Bladder thickness 7.1%.A P-Value of ≤0.05 was found when all these ultrasonographic findings were correlated withseverity of disease in terms of decrease in numbers of platelets. Conclusion: DEN Virus iscommon most disease in our part of world. This study shows maximum number of patients withNS-1 shows hepatomegaly and spleenomegaly in ultrasonographic changes and the positiverelation has been shown between decrease in platelets count with ultrasonographic findings.