Biological and Clinical Sciences Research Journal

Diagnostic Accuracy of Thyroid Doppler in Predicting Malignancy in Thyroid Nodules, Keeping Histopathology as Gold Standard

2025-05-14T08:45:49+00:00

Thyroid nodules are common clinical findings with varying etiologies, ranging from benign lesions to malignant tumors. Accurate preoperative evaluation is crucial to avoid unnecessary surgeries. Doppler ultrasonography offers a non-invasive modality for assessing vascular characteristics associated with malignancy. However, its diagnostic performance varies across clinical settings. Objective: To evaluate the diagnostic accuracy of Doppler ultrasonography in detecting malignancy in thyroid nodules, using histopathological examination as the gold standard. Methods: This prospective observational study was conducted at KRL Hospital, Islamabad, from December 15, 2024, to March 15, 2025. Ethical approval was obtained from the Institutional Review Board. 150 patients (aged >18 years, both genders) with thyroid nodules identified clinically or through routine imaging were enrolled using non-probability consecutive sampling. Doppler ultrasonography was performed for all participants, followed by histopathological evaluation after surgical excision or fine-needle aspiration. Statistical analysis was carried out using SPSS v25. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and receiver operating characteristic (ROC) curves were calculated for both modalities. Results: Doppler ultrasonography demonstrated a sensitivity of 82.6%, specificity of 77.3%, and an overall diagnostic accuracy of 80% in identifying malignant thyroid nodules. In comparison, histopathology revealed superior diagnostic metrics with a sensitivity of 97.06%, specificity of 90.24%, PPV of 89.19%, NPV of 97.37%, and diagnostic accuracy of 93%. The ROC curve analysis for histopathology confirmed high diagnostic performance with an AUC of 0.937. Conclusion: Doppler ultrasonography is a valuable, moderately accurate, and non-invasive diagnostic tool for assessing malignancy in thyroid nodules. Despite its moderate sensitivity and specificity, it remains a practical initial imaging modality, though histopathology remains the definitive diagnostic standard.

Outcome Of Conservative Management Of Blunt Abdominal Trauma In Children

2025-03-13T13:49:13+00:00

Blunt abdominal trauma (BAT) is a leading cause of pediatric morbidity and mortality, particularly in low-resource settings like Pakistan, where road traffic accidents (RTAs) and falls are major contributors. The standard of care has shifted from mandatory surgical intervention to non-operative management (NOM) for hemodynamically stable patients with solid organ injuries. This study evaluates the outcomes of conservative management of pediatric BAT in a tertiary care hospital in Pakistan, assessing its success rate, complications, and factors contributing to treatment failure. Methods: This prospective observational study was conducted at Pakistan Institute of Medical Sciences (PIMS), Islamabad, over six months (October 2024 to March 2025). A total of 90 pediatric patients (≤16 years) with confirmed BAT were enrolled. Patients were stratified based on injury severity using the American Association for the Surgery of Trauma (AAST) grading system and managed conservatively if hemodynamically stable. Primary outcomes included NOM success rate, need for surgical intervention, and mortality. Secondary outcomes included hospital length of stay, blood transfusion requirements, and complications such as secondary hemorrhage and delayed splenic rupture. Data were analyzed using SPSS version 26, with a p-value of <0.05 considered statistically significant. Results: NOM was successful in 78 patients (86.7%), with failure observed in 12 patients (13.3%), primarily those with severe injuries requiring surgical intervention. The most commonly injured organs were the spleen (40.0%) and liver (38.9%). RTAs were the leading cause of BAT (53.3%), followed by falls (30.0%). Complications included secondary hemorrhage (11.1%), delayed splenic rupture (6.7%), and infection (10.0%). ICU admission was required in 24.4% of cases, while 27.8% required blood transfusions. The mean hospital stay was 5.7 ± 2.3 days, with prolonged stays observed in severe cases. Conclusion: This study demonstrates that NOM is a safe and effective approach for managing pediatric BAT in Pakistan, with a high success rate and favorable patient outcomes. The findings highlight the importance of strict hemodynamic monitoring, timely transfusion support, and selective surgical intervention in high-risk cases. Given the increasing burden of pediatric trauma due to RTAs and falls, efforts should be directed toward improving trauma care infrastructure, enhancing training for NOM protocols, and implementing preventive strategies to reduce pediatric injury rates in Pakistan.

Attitudes, Knowledge, and Practices Regarding Chronic Kidney Disease Among Patients

2025-05-09T09:23:33+00:00

Chronic kidney disease (CKD) poses a growing public health burden globally, particularly in low- and middle-income countries like Pakistan. Patient knowledge, attitudes, and practices (KAP) are key factors influencing disease management and outcomes. Objective: To assess the knowledge, attitudes, and practices regarding CKD among patients receiving care in a tertiary care hospital in Lahore, Pakistan. Methods: A descriptive cross-sectional study was conducted at Sheikh Zayed Hospital, Lahore. A sample of 180 CKD patients was recruited using convenience sampling. Data were collected using a structured, validated questionnaire covering demographic characteristics, knowledge, attitudes, practices, and risk factor awareness. Statistical analysis was conducted using SPSS version 25. Reliability was assessed via Cronbach’s alpha, and validity was evaluated using KMO and Bartlett’s tests. Results: The majority of participants were male (59.4%) and aged between 26–45 years. High levels of knowledge were observed regarding the progressive nature of CKD and the roles of hypertension and diabetes as risk factors. Attitudes were generally favorable, particularly regarding the importance of awareness and equal treatment. Practices such as medication adherence and blood pressure monitoring were common, but exercise and dietary compliance were low. Awareness of less common CKD risk factors such as aging, autoimmune disease, and NSAID use was limited. Cronbach’s alpha values ranged from 0.295 to 0.732 across domains, and KMO values confirmed construct validity. Conclusion: The study highlights moderate to high knowledge and positive attitudes toward CKD among patients, but also reveals gaps in practice and awareness of lesser-known risk factors. Targeted educational interventions are needed to promote comprehensive disease understanding and self-care behaviors.

Impact of Genital Hygiene Awareness on Adolescent Girls in Public Schools, Karachi: Behavioral and Influencing Factors (Quasi-Experimental Study)

2025-05-05T12:13:38+00:00

Genital hygiene encompasses a range of personal care practices essential for maintaining the urogenital health of adolescent girls. Inadequate knowledge and improper hygiene behaviors can lead to increased susceptibility to infections, reproductive tract diseases, and compromised reproductive health, particularly in resource-limited settings such as Pakistan. Objective: To determine the impact of awareness on genital hygiene behavior and its associated factors among girls studying in secondary schools in Karachi, Pakistan. Methods: A quasi-experimental pre-post intervention study was conducted at a higher secondary school in Karachi, Pakistan, from July 2024 to February 2025. A purposive sampling technique was employed to recruit participants. Data were collected using a structured, pre-tested questionnaire after obtaining formal permission from school authorities. The intervention included an awareness session on genital hygiene. The collected data were coded, tabulated, and analyzed using SPSS. Socio-demographic characteristics were described, and the Wilcoxon signed-rank test was applied to assess changes in hygiene behaviors before and after the intervention. Statistical significance was considered at p < 0.05. Results: Most participants were aged 15–16 (53%). Most fathers had incomplete or completed primary education, whereas mothers were likelier to have attained secondary or higher education. About 56% of the families reported income below their household expenses. Post-intervention results showed a statistically significant improvement in genital hygiene practices, including regular sanitary pads during menstruation, daily bathing, frequent changing of cotton undergarments, and proper drying of the genital area after washing (p < 0.05). Conclusion: The findings highlight the critical role of school-based awareness interventions in improving genital hygiene behaviors among adolescent girls. Educational programs tailored to address reproductive health and hygiene can empower young females and enhance their health outcomes.

Comparison Between Efficacy of Norepinephrine and Phenylephrine Boluses for Prevention of Spinal Anesthesia-Induced Hypotension in Obstetrical Patients Undergoing Emergency Cesarean Section

2025-04-28T07:08:09+00:00

Spinal anesthesia-induced hypotension (SAH) is a common complication during emergency cesarean sections, which can negatively affect both maternal and neonatal outcomes. This study aims to compare the efficacy of norepinephrine and phenylephrine boluses in preventing SAH in obstetric patients. Objective: To compare the efficacy of norepinephrine and phenylephrine boluses for preventing spinal anesthesia-induced hypotension (SAH) in obstetric patients undergoing emergency cesarean section. Methods: A double-blind randomized controlled trial was conducted at Dr. Ruth K.M. Pfau Civil Hospital Karachi, Dow University of Health Sciences, from 1st January 2025 to 31st March 2025. A total of 124 obstetric patients undergoing emergency cesarean section under spinal anesthesia were randomly assigned into two groups: norepinephrine (N) and phenylephrine (P). Each group consisted of 62 patients. The primary outcome was the incidence of hypotension following spinal anesthesia, while secondary outcomes included the need for additional vasopressor boluses, maternal and neonatal outcomes, and side effects. Statistical analysis was performed using Chi-square tests, with a p-value <0.05 considered statistically significant. Results: The overall incidence of hypotension was 58 (46.77%). The rate of spinal anesthesia-induced hypotension was significantly higher in the phenylephrine group compared to the norepinephrine group (56.45% vs. 37.1%; p=0.031). The proportion of infants with an Apgar score <7 at one minute was significantly higher in the phenylephrine group than in the norepinephrine group (33.9% vs. 6.5%; p=0.0005). Conclusion: A prophylactic bolus dose of norepinephrine demonstrated superior efficacy compared to phenylephrine for the prevention of spinal anesthesia-induced hypotension in parturients undergoing emergency cesarean section.

Comparison of Early Versus Late Removal of Foley’s Catheter in Patients After Transurethral Resection of Prostate

2025-04-23T10:01:23+00:00

The primary surgical intervention addressing urinary blockage caused by an enlarged non-cancerous prostate involves a procedure performed via the urethra. Despite its widespread use, protocols for the timing of catheter withdrawal after surgery differ significantly. This research aimed to evaluate outcomes between patients undergoing immediate versus postponed catheter extraction, analyzing factors such as hospitalization duration, volume of tissue excised during the procedure, operative time, need for blood transfusions during or after surgery, and adverse events following the intervention. Methods: This prospective clinical investigation was conducted at the Department of Urology, Victoria Hospital, Bahawalpur, from 25th December 2024 to 25th March 2025. Patients were chosen through a random selection methodology following consent authorization and categorized into two groups: Group A-standard catheter removal group, and Group B-early catheter removal group. Exclusion criteria comprised individuals with elevated residual urinary retention, concurrent urethral procedures alongside prostate tissue excision, underlying medical conditions, and surgical challenges during the operation. Patients were cleared for discharge post-catheter extraction contingent on demonstrating proper urination. In Group A, drainage tubes were retained beyond 24 hours per established guidelines. The data were analyzed using SPSS-17. Results: The study was conducted with 320 patients, 163 in Group A and 157 in Group B. The average mass of excised tissue in Group A was 46.67±9.133 grams; it was 45.22±7.532 grams in Group B. The Mean catheter removal day was 4.13±1.65days in Group A and 1.23±0.933 days in Group B. Hospitalization periods differed markedly, with Group A averaging 3.57 days±1.028 and 1.29 days±1.030 in Group B (p-value<0.05). A direct relationship was observed between hospitalization duration and the timing of catheter extraction. Both groups demonstrated comparable rates of post-surgical adverse events, with no notable discrepancy in clinical outcomes. Conclusion: Removal of the catheter on the first postoperative day after transurethral prostatectomy does not heighten the likelihood of post-surgical adverse effects and is correlated with reduced hospitalization duration.

Diagnostic Accuracy of Carotid Doppler Ultrasound for Detection of Carotid Artery Stenosis in Ischemic Stroke Patients: Keeping Computed Tomography Angiography as the Gold Standard

2025-04-16T09:27:07+00:00

Carotid artery stenosis is a significant risk factor for ischemic stroke. Early and accurate identification of stenosis is critical for preventing stroke recurrence and improving clinical outcomes. Carotid Doppler Ultrasound (CDU) offers a non-invasive, bedside screening modality, but its diagnostic accuracy compared to Computed Tomography Angiography (CTA) requires further evaluation. Objective: To assess the diagnostic accuracy of CDU in detecting carotid artery stenosis in ischemic stroke patients, CTA was used as the reference standard. Methods: This diagnostic accuracy study was conducted at Combined Military Hospital (CMH), Kharian, and included 95 patients with ischemic stroke who underwent both CDU and CTA. CDU was performed by experienced sonographers, assessing stenosis using peak systolic velocity and intima-media thickness. CTA was interpreted by radiologists blinded to CDU findings. The diagnostic performance of CDU was measured in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy, with CTA serving as the gold standard. Results: Among the 95 patients, CDU demonstrated a sensitivity of 91%, specificity of 77%, PPV of 47.3%, NPV of 92.5%, and overall diagnostic accuracy of 80%. CDU showed strong performance in identifying patients without significant stenosis but had moderate specificity in confirming the presence of stenosis. Conclusion: CDU is a valuable screening tool for carotid artery stenosis in ischemic stroke patients, particularly in settings with limited access to advanced imaging. However, confirmatory CTA remains necessary for definitive diagnosis due to its limited specificity and PPV. When supported by appropriate follow-up imaging, integrating CDU into stroke workups can enhance early detection and streamline care pathways.

Frequency of Breast Abscess Among Lactating Women in a Tertiary Care Hospital

2025-05-14T13:02:36+00:00

Breast abscess is a relatively common complication during lactation, often resulting in pain, discomfort, and interruption of breastfeeding. Prompt diagnosis and management are essential to prevent morbidity, yet its reported incidence varies across populations. Objective: To ascertain the frequency of breast abscess among lactating women presenting to a tertiary care hospital in Karachi, Pakistan. Methods: A descriptive cross-sectional study was conducted in the Department of Surgery at Kulsoombai Valika Social Security Hospital, Karachi, from July 2024 to December 2024. After obtaining ethical approval from the institutional review board, a total of 151 lactating women aged 20–40 years, presenting with a painful breast lump and swelling for at least 3 days, were enrolled through non-probability consecutive sampling. Data on sociodemographic variables, parity, and clinical presentation were collected. Descriptive statistics were used for baseline characteristics, and the Chi-square test was applied to evaluate associations between categorical variables. A p-value < 0.05 was considered statistically significant. Results: The mean duration of symptoms among participants was 8.2 ± 3.4 days. Breast abscess was diagnosed in 12% of the cases (n = 19). The occurrence of abscess did not show a statistically significant association with socioeconomic status (P = 0.744), with distribution as follows: poor (n = 6), middle class (n = 11), and rich (n = 2). Similarly, no significant relationship was observed between parity and abscess development (P = 0.626); 11 abscess cases were observed in women with parity ≤3 and 8 cases in those with parity >3. Conclusion: The study identified a 12% frequency of lactational breast abscess among the participants, which falls within the higher range reported in the literature. No significant association was observed with socioeconomic status or parity. Early detection and proper management are crucial to minimizing complications in lactating women.

ELISA-Based Seroprevalence and Risk Factors for Toxocara Canis and Dirofilaria Immitis in Dogs in Khyber Pakhtunkhwa, Pakistan

2025-04-14T10:38:59+00:00

Parasites are responsible for several important and widespread zoonotic diseases transmitted through companionship between animals and humans. Zoonotic parasitic infections impact human and animal health and food safety and have significant economic implications. Limited data on the seroprevalence of Toxocara canis and Dirofilaria immitis infections in household dogs in Khyber Pakhtunkhwa, Pakistan. Objective: To determine the seroprevalence of Toxocara canis and Dirofilaria immitis in household dogs using a serological technique and to assess the associated risk factors. Methods: This cross-sectional study included 405 dog blood samples collected from veterinary facilities and private pet clinics across Khyber Pakhtunkhwa. An ELISA test was used to detect anti-Toxocara and anti-Dirofilaria IgG antibodies. Data regarding gender, age, area (rural/urban), and deworming status were gathered from owners through questionnaires. Chi-square tests were used to determine associations between seroprevalence and potential risk factors, with a significance level set at p < 0.05. Results: The overall seroprevalence was 22.71% (92/405; 95% CI: 18.9%–27.0%) for Toxocara canis and 2.22% (9/405; 95% CI: 1.1%–4.1%) for Dirofilaria immitis. For Toxocara canis, area (rural vs. urban, p < 0.05) and deworming status (p < 0.05) were significantly associated with infection. Age and gender were not significantly associated with Toxocara canis infection (p > 0.05). None of the investigated risk factors showed a statistically significant association with Dirofilaria immitis seroprevalence (p > 0.05). Conclusion: The study highlights a substantial seroprevalence of Toxocara canis and a lower prevalence of Dirofilaria immitis among household dogs in Khyber Pakhtunkhwa. Risk factors such as living in rural areas and a lack of deworming were associated with higher Toxocara infection rates. Effective control requires a comprehensive "One Health" strategy collaboratively addressing animal and human health.

Clinicoradiological Profile of Patients Presenting With Idiopathic Intracranial Hypertension in Outpatient Department of Neurology, Jinnah Postgraduate Medical Centre

2025-05-14T11:22:26+00:00

Idiopathic intracranial hypertension (IIH), a disorder characterized by elevated intracranial pressure without an identifiable cause, presents with varied clinical and radiological features. Early recognition and characterization are essential to prevent complications such as vision loss. Data from Pakistan regarding the clinicoradiological spectrum of IIH remains limited. Objective: To determine the clinicoradiological profile of patients presenting with idiopathic intracranial hypertension in the outpatient department of neurology at Jinnah Postgraduate Medical Centre (JPMC), Karachi. Methods: This descriptive cross-sectional study was conducted at Ward 28, Department of Neurology, JPMC, Karachi, from January 10, 2025, to April 10, 2025, following approval from the institutional ethical review board. A total of 90 patients aged 18–50 years of both genders with a confirmed diagnosis of IIH were enrolled using non-probability consecutive sampling. Clinical features including headache, pulsatile tinnitus, visual symptoms, and retrobulbar pain were documented. Radiological assessments using MRI and MRV focused on identifying features such as empty sella, tortuous optic nerves, transverse sinus stenosis, and scleral flattening. Data were analyzed using SPSS Version 25. Results: The mean age of patients was 35.02 ± 9.8 years. Females constituted a greater proportion (57%, n=51) compared to males (43%, n=39). Most common clinical symptoms were blurred vision (59%, n=53), transient visual obscuration (TVO) (57%, n=51), retrobulbar pain (56%, n=50), and headache (53%, n=48). Radiological findings showed empty sella in 42% (n=38), tortuous optic nerves in 44% (n=40), transverse sinus stenosis in 49% (n=44), and scleral flattening in 51% (n=46). Conclusion: This study underscores the predominance of IIH in middle-aged females and highlights visual disturbances and retrobulbar pain as frequent presenting complaints. Radiological findings such as transverse sinus stenosis and scleral flattening were prevalent, supporting their utility in the diagnostic evaluation of IIH. A multidisciplinary approach is crucial for early diagnosis and vision preservation.

Intracerebral Hemorrhage in a Young Urban Population: Etiologies and Outcomes in Patients 50 and Younger Presenting in the Department of Neurology, Jinnah Postgraduate Medical Centre

2025-04-10T09:58:18+00:00

Intracerebral hemorrhage (ICH) in young adults is a significant neurological emergency associated with considerable morbidity and mortality. Understanding its etiological profile and prognosis is essential for timely management and prevention. Objective: To determine the etiologic profile and prognosis of intracerebral hemorrhage (ICH) in patients aged 18–50 years presenting to the Neurology Department at Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. Methods: A cross-sectional study was conducted at Ward 28, Department of Neurology, JPMC Karachi, from December 7, 2024 to March 7, 2025, after obtaining ethical approval. One hundred twenty-nine patients aged 18–50 years with confirmed ICH (within 24 hours of onset) were enrolled using non-probability consecutive sampling. Demographic and clinical data, including comorbidities such as hypertension, diabetes mellitus, hyperlipidemia, cerebral amyloid angiopathy (CAA), and anticoagulant use, were recorded. Patient outcomes were assessed at hospital discharge. Results: The mean systolic blood pressure was 143.6 ± 21.5 mmHg. Hypertension was the most prevalent comorbidity, present in 64 patients (50%), followed by hyperlipidemia in 39 (30%), diabetes mellitus in 25 (19%), anticoagulant use in 19 (15%), and cerebral amyloid angiopathy in 13 (10%). Out of the total, 104 patients (81%) were discharged successfully, while 25 (19%) died during hospitalization. Conclusion: Intracerebral hemorrhage in young adults is associated with high morbidity and mortality, with hypertension being the most common underlying risk factor. These findings highlight the need for aggressive risk factor management in younger populations to reduce the burden of ICH.

The Boey Score as a Quick Assessment Tool in the Prediction of Postoperative Mortality in Patients with Hollow Viscus Perforation: A Study in Karachi, Pakistan

2025-05-14T10:18:34+00:00

Hollow viscus perforation (HVP) is a surgical emergency with significant morbidity and mortality. The Boey score, incorporating preoperative shock, medical comorbidities, and delay in surgical intervention, serves as a predictive model for postoperative outcomes. Early identification of high-risk patients through this scoring system may assist in optimizing treatment approaches and improving survival rates. Objective: To determine the frequency of mortality in patients with hollow viscus perforation according to their Boey score. Methods: This descriptive cross-sectional study was conducted at the Department of Surgery, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, from July 2024 to January 2025. After ethical approval, 185 patients aged >18, of either gender, presenting with a confirmed diagnosis of HVP, were enrolled via non-probability consecutive sampling. Data were collected on demographic variables, clinical parameters, Boey score components, and outcomes. Statistical analysis was performed using SPSS version 25. Chi-square tests assessed associations between mortality and patient characteristics; a p-value <0.05 was considered statistically significant. Results: Out of 185 patients, mortality was observed in 21 cases (11.35%). Age and gender showed no statistically significant association with mortality (p = 0.55 and p = 0.197, respectively). However, a statistically significant relationship was found between delayed presentation (>24 hours) and increased mortality (p = 0.034). Among patients presenting within 24 hours, only 3 out of 65 died, whereas in those presenting after 24 hours, 18 out of 120 died. The Boey score effectively stratifies patients based on risk, with higher scores correlating with higher mortality. Conclusion: The Boey score is a reliable prognostic tool for assessing mortality risk in patients with hollow viscus perforation. Delayed presentation significantly increases mortality, emphasizing the need for prompt diagnosis and intervention.

A Comparison of the Effects of Skin-to-Skin Contact Versus Conventional Method on Newborn Body Temperature

2025-03-29T12:48:23+00:00

Neonatal thermal protection remains a significant global issue and a challenge for medical professionals. Maintaining the newborn in a natural thermal environment is essential by keeping them on their mother's belly for as long as possible. Objective: The current study aimed to compare the change in newborns mean body temperature after skin-to-skin contact and conventional Method: Materials and method: The current randomised control trial study was carried out at the gynecology and Obstetrics department Sheikh Zayed Hospital and college Rahim Yar Khan over three months from December 16, 2024 to March 16, 2025 after taking permission from the ethical board of the institute. Non-probability consecutive sampling was employed, and the sample size was calculated using the WHO sample size calculator. The sample consisted of 120 participants, divided into two groups of 60 each. Using the lottery approach, the mothers were split into two groups: Group B (skin-to-skin contact) and Group A (baby warmer group). In Group A, the newborns were dried and covered with a warm towel within ten minutes of birth. The infant was kept in a radiant warmer for at least an hour. In Group B, within 10 minutes after birth, the newborns were placed on the mother's chest, preserving skin-to-skin contact. Using a digital thermometer, the principal investigator used data collection procedures to monitor the newborn's axillary body temperature at 15, 30, and 60 minutes after birth. SPSS version 26.0 was used to analyse the data. A p-value of ≤ 0.05 was considered statistically significant. Results: Compared to the A group, participants in the B group were younger. In both groups, the most prevalent age group was 25 to 31 years. The average length of stay in the hospital was 6.5 ± 1.5 hours. The average length of hospital stay using the conventional method was 6.5 ± 1.5 hours, while the average length of skin-to-skin mother contact was 6.7 ± 1.8 hours. Patients' health responses were determined to be 15 (25%) in the Conventional Approach group and 36 (60%) in the Skin-to-Skin Mother-Contact group. After 60 minutes, a statistically significant mean temperature difference was observed between the two groups (p = 0.001); however, no significant mean temperature difference was found after 30 or 15 minutes (p > 0.05). Conclusion: The current study concluded that Skin-to-skin contact should be encouraged and maintained, as it helps lower the risk of hypothermia. It is inexpensive, simple, and promotes bonding between mothers and children.

Diagnostic Accuracy of Echocardiography in Assessment of Ejection Fraction Taking CT-Cardiac Function Analysis as Gold Standard

2025-05-13T10:13:22+00:00

Ejection fraction (EF) is a vital parameter in assessing cardiac function and guiding therapeutic decisions. While echocardiography remains the most commonly used modality due to its non-invasiveness and accessibility, its diagnostic accuracy in EF estimation has been debated. Cardiac computed tomography (CT), although less frequently utilized, offers potential advantages in EF evaluation. Objective: To determine the diagnostic accuracy of ejection fraction (EF) measurements obtained via echocardiography and to compare these results with those obtained from cardiac CT. Methods: This observational, comparative study was conducted at KRL Hospital, Islamabad, from December 15, 2024, to March 15, 2025. After obtaining ethical approval from the institutional review board, a total of 100 patients aged 20–70 years of both genders, presenting with suspected or known cardiac conditions requiring EF assessment, were recruited through non-probability consecutive sampling. EF was measured for all participants using both transthoracic echocardiography and cardiac CT. Sensitivity and specificity for detecting abnormal EF were calculated using CT findings as the reference standard. Statistical analysis was conducted using SPSS version 25. Results: Echocardiography demonstrated moderate diagnostic accuracy for EF assessment, with a sensitivity of 55% and specificity of 67%. In contrast, cardiac CT showed superior diagnostic performance, achieving a sensitivity of 74% and specificity of 80% in detecting abnormal EF. Conclusion: Echocardiography provides moderate diagnostic accuracy for evaluating ejection fraction, with relatively lower sensitivity and specificity compared to cardiac CT. The findings suggest that cardiac CT may serve as a more reliable modality for EF assessment, particularly in cases where precise evaluation is critical.

Association of Knowledge and Quality of Life With the Intake of Dietary Supplements Among the Students

2025-05-09T05:18:29+00:00

Dietary supplements refer to the products that contain vitamins, minerals, herbs, amino acids, oil supplements, or other substances intended to supplement the diet. Nutrient deficiencies are frequently addressed with dietary supplements. Supplements can fill in these gaps and ensure that you get enough nutrients. Objectives: The aim of the study was to assess the frequency of dietary supplement intake, to assess the association between knowledge and intake of dietary supplements and to assess the association of quality of life with the intake of dietary supplements among the university students. Methodology: It was an analytical cross-sectional study which was conducted among the students at the University of Lahore. Probability Simple Random Sampling was employed to select students of the departments, and the data was gathered through self-administrated questionnaire. The data was analyzed using SPSS version 25.0. Used SF-36 questionnaire to measure quality of life while a pre validated self-administered questionnaire was used to access the knowledge and intake of dietary supplements. Results: Data from 266 participants was collected. The frequency of dietary supplement use among students was 75.9%. Intake of dietary supplement was higher in females (71%) as compared to males (60.5%). Moreover, it revealed a significant association between the level of knowledge about dietary supplements with the intake of dietary supplements (p-value < 0.05). Intake of dietary supplement was higher among those students who have adequate knowledge regarding dietary supplements (88.1%) as compared to those who have inadequate knowledge regarding dietary supplements (73.7%). However, no significant difference was observed in the domains of quality of life between ds users and non-ds users. (p>0.05) except for physical functioning (p=0.041*). Conclusions: It was observed that the use of dietary supplements increases the physical functioning capacity of its users.

Immunization Status of Children Admitted With Measles in a Tertiary Care Hospital

2025-05-05T10:53:41+00:00

Measles continues to pose a pervasive threat in pediatric healthcare, as it not only has a high rate of transmissibility but also has the potential to lead to severe complications such as pneumonia and encephalitis. Objective: To determine the immunization status of children presenting with measles at a tertiary care hospital. Methods: This Cross-Sectional study design was conducted at the Dept of Pediatrics – Patel Hospital, Karachi, during July 2024 to December 2024. Ethical approval was secured from the Institutional Review Board of the designated tertiary care hospital before data collection began. Pediatric patients admitted with measles were identified and enrolled as study participants after obtaining informed consent from their guardians or parents. Data were gathered using a structured questionnaire designed to capture sociodemographic details, disease history, clinical symptoms, and immunization status. Results: Data were collected from 261 children with a majority being male (59.77%). The mean age was 4.6 years (±2.3). Socioeconomic distribution showed that most participants belonged to low-income families (65%), while middle-income (22%) and high-income (13%) families had lower representation. Regarding parental education, 58% of parents had no formal education, 27% had primary education, and only 15% had secondary or higher education, highlighting educational disparities among the participants' families. Conclusion: It is concluded that immunization plays a critical role in preventing measles and reducing its complications, with fully vaccinated children experiencing significantly lower rates of severe outcomes compared to unvaccinated ones.

Pain And Anxiety During AV Fistula Cannulation Among Hemodialysis Patients

2025-04-23T10:57:17+00:00

AV fistula cannulation is a routine yet often painful and anxiety-inducing procedure for patients undergoing maintenance hemodialysis. Despite its frequency, procedural pain and psychological distress remain under-addressed, especially in low-resource settings like Pakistan. Objective: To assess the severity and prevalence of pain and anxiety during AV fistula cannulation among hemodialysis patients in a tertiary care hospital in Pakistan. Methods: This cross-sectional descriptive study was conducted at the Dialysis Unit, Department of Nephrology, Nishtar Hospital Multan, from 15 December to 15 March. A total of 135 patients undergoing maintenance hemodialysis through AV fistula were included. Pain was evaluated using the Visual Analog Scale (VAS), and anxiety was measured using the Hospital Anxiety and Depression Scale – Anxiety subscale (HADS-A). Data were analyzed using SPSS v25, with chi-square tests for statistical significance (p<0.05). Results: Pain during cannulation was reported by 92.6% of patients, with 28.1% experiencing mild, 38.5% moderate, and 25.9% severe pain. Anxiety was present in 62.9% of patients (31.1% mild, 20.7% moderate, 11.1% severe). Significant associations were found between anxiety and female gender (p<0.05), as well as between severe pain and longer dialysis duration (p=0.032). Conclusion: Pain and anxiety are highly prevalent during AV fistula cannulation among Pakistani hemodialysis patients. Integrating pain management and psychological screening into routine dialysis care may significantly improve the well-being of this vulnerable population.

Prevalence and Risk Factors of Polycystic Ovary Syndrome (PCOS) Among Adolescent Girls in Urban and Rural Pakistan

2025-04-18T21:35:34+00:00

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting females during adolescence and reproductive years, with increasing prevalence in South Asia. This study aimed to determine the prevalence of PCOS and identify associated clinical and lifestyle risk factors among adolescent girls in urban and rural areas of Pakistan. Methods: A cross-sectional study was conducted at Jamila Fareedi Medical Center in Pakistan from April to September 2024. Eighty-six adolescent girls aged 13–19 were recruited from urban and rural settings. PCOS was diagnosed based on the Rotterdam criteria. Clinical assessments included anthropometric measurements, menstrual history, signs of hyperandrogenism, and lifestyle factors. Biochemical investigations included levels of LH, FSH, testosterone, and insulin. Insulin resistance was calculated using HOMA-IR. Data were analyzed using SPSS v26, with p < 0.05 considered statistically significant. Results: The overall prevalence of PCOS was 26.7%, with a higher prevalence among urban girls (34.1%) compared to rural girls (19.0%). PCOS was significantly associated with a higher BMI (p = 0.02), physical inactivity (p = 0.01), frequent consumption of junk food (p = 0.006), sleep deprivation (p = 0.01), and an elevated LH: FSH ratio (p < 0.001). Hirsutism, acne, and menstrual irregularities were more prevalent in the PCOS group. Insulin resistance (HOMA-IR > 2.5) was observed in 60.9% of patients with PCOS compared to 17.5% of non-PCOS participants. Conclusion: PCOS is prevalent among adolescent girls in Pakistan, particularly in urban areas, and is strongly associated with modifiable lifestyle and metabolic risk factors. Early screening, education, and targeted interventions are urgently needed to prevent long-term reproductive and metabolic complications.

Frequency of Survival of Endodontically Treated Teeth Restored With Filling or Crown

2025-04-15T13:55:31+00:00

The long-term success of endodontically treated teeth significantly depends on the quality of the final restoration. Whether direct (fillings) or indirect (crowns), restorations are critical in protecting tooth structure and preventing reinfection. However, comparative survival outcomes of these restorations remain under-evaluated in clinical settings. Objective: To determine the survival frequency of endodontically treated teeth restored with either a direct filling or a crown. Methods: This cross-sectional descriptive study was conducted at the Department of Operative Dentistry, Islamic International Dental Hospital, Islamabad, from September 30, 2024, to March 29, 2025. One hundred six endodontically treated teeth from patients aged 13 to 60 were assessed. Dentists treated eligible cases with a minimum qualification of BDS. Clinical evaluation included assessing periodontal status, cracks or fractures, bleeding on probing, and attachment loss. Radiographic evaluation assessed the quality of root canal obturation and bone loss. Data were collected via case history interviews and analyzed using descriptive statistics in SPSS version 26. Results: The mean age of the participants was 37.79 ± 14.03 years, with a higher proportion of female patients. Out of 106 evaluated teeth, 97 (91.5%) remained clinically and radiographically successful following endodontic treatment and subsequent restoration with either a filling or a crown. Conclusion: This study demonstrates a high survival rate (91.5%) for endodontically treated teeth restored with either a filling or a crown, emphasizing the effectiveness of both restorative modalities in maintaining tooth integrity post-treatment.

Factors Leading to Delay in Diagnosis of Myasthenia Gravis

2025-05-14T11:56:14+00:00

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder with variable presentations, often mimicking other conditions, which leads to delayed diagnosis. Early identification and management are critical to prevent morbidity and improve prognosis. In resource-limited settings like Pakistan, diagnostic delays may be influenced by clinical, systemic, or diagnostic limitations. Objective: To determine the factors contributing to delayed diagnosis of myasthenia gravis among patients presenting to the Department of Neurology at Jinnah Postgraduate Medical Centre, Karachi. Methods: This cross-sectional study was conducted in Ward 28, Department of Neurology, Jinnah Postgraduate Medical Centre (JPMC), Karachi, from December 12, 2024, to April 13, 2025. After obtaining ethical approval from the institutional review board, a total of 172 patients aged 18–72 years of both genders, diagnosed with myasthenia gravis, were recruited through non-probability consecutive sampling. Data on demographic characteristics, presenting symptoms, duration before diagnosis, and treatment modalities were collected using a structured proforma. The primary outcome was the duration of diagnostic delay (≤1 year vs. >1 year). Chi-square tests were used for categorical variables, and a p-value <0.05 was considered statistically significant. Results: Among 172 patients, 87 (51%) experienced a diagnostic delay of more than one year, while 85 (49%) were diagnosed within one year of symptom onset. The most frequent presenting symptom was ptosis (32%), followed by diplopia (24%), dysphagia (23%), and generalized fatigue or muscle weakness (15%). Anticholinesterase therapy was the most common treatment modality (29%), followed by immunosuppressants (25%), plasmapheresis (24%), and IVIG (22%). Notably, 58% of patients with delayed diagnosis had negative laboratory test results compared to 42% in those diagnosed earlier (p = 0.022), indicating a statistically significant association. Conclusion: A substantial proportion of myasthenia gravis patients experience diagnostic delays exceeding one year. Non-specific initial symptoms and negative laboratory findings are major contributors. Enhancing clinical suspicion and improving diagnostic protocols in tertiary care settings may facilitate timely diagnosis and reduce disease burden.

Comparison of Oxcarbazepine Versus Carbamazepine in the Management of Trigeminal Neuralgia in Patients Presenting in the Outpatient Department of Neurology, Jinnah Postgraduate Medical Centre

2025-04-10T11:06:30+00:00

Trigeminal neuralgia is a chronic pain condition characterized by recurrent episodes of severe facial pain. Carbamazepine is the first-line pharmacological treatment, but oxcarbazepine has emerged as a potential alternative with better tolerability and fewer side effects. Objective: To compare the efficacy of oxcarbazepine and carbamazepine in managing trigeminal neuralgia in patients presenting to the outpatient department of Neurology at Jinnah Postgraduate Medical Centre (JPMC), Karachi. Methods: This randomized controlled trial was conducted at Ward 28, Department of Neurology, JPMC, Karachi, from 21st September 2024 to 21st March 2025 after ethical approval from the institutional review board. A total of 122 patients aged 25–80 years of either gender with a clinical diagnosis of trigeminal neuralgia were enrolled using non-probability consecutive sampling. Patients with a history of surgical intervention for trigeminal neuralgia were excluded. Participants were randomly assigned to receive either oxcarbazepine or carbamazepine, and treatment efficacy was evaluated using the Visual Analogue Scale (VAS) for pain intensity. The primary endpoint was pain relief, and treatment response was categorized as good, moderate, or unresponsive. Results: Patients treated with oxcarbazepine demonstrated significantly greater pain relief than those on carbamazepine, as reflected by a lower mean VAS score (2.6 ± 1.2 vs. 3.7 ± 1.89, p = 0.001). Efficacy analysis revealed a good response in 69% of the oxcarbazepine group compared to only 20% in the carbamazepine group (p < 0.0001). Moreover, 66% of patients in the carbamazepine group remained unresponsive, whereas only 13% in the oxcarbazepine group showed no improvement. Conclusion: Oxcarbazepine is more effective and better tolerated than carbamazepine in managing trigeminal neuralgia, providing superior pain control and a more favorable response profile. These findings support oxcarbazepine as a preferable first-line treatment option in clinical practice.

Frequency of Psychogenic Non Epileptic Seizures in Patients Presenting in the Department of Neurology, Jinnah Postgraduate Medical Centre, Karachi

2025-05-14T10:28:39+00:00

Psychogenic non-epileptic seizures (PNES) are clinical events that resemble epileptic seizures but lack the characteristic electrical discharges associated with epilepsy. Often underdiagnosed, PNES are frequently associated with psychological stressors and psychiatric comorbidities. In Pakistan, limited data exists on the frequency and associated factors of PNES in neurological settings. Objective: To determine the frequency of psychogenic non-epileptic seizures among patients presenting to the Department of Neurology at Jinnah Postgraduate Medical Centre (JPMC), Karachi, and to identify associated psychiatric comorbidities. Methods: This descriptive cross-sectional study was conducted at Ward 28, Department of Neurology, JPMC, Karachi, from January 13, 2025, to April 13, 2025, following ethical approval from the Institutional Review Board. A total of 151 patients aged between 12 and 60 years, of both genders, who presented with clinical features suggestive of PNES were recruited using non-probability consecutive sampling. Detailed psychiatric histories were recorded. Data were analyzed using SPSS; associations between PNES and psychiatric variables were assessed using Chi-square tests with a significance threshold of p < 0.05. Results: Out of 151 patients, PNES were confirmed in 79 individuals (51%). A significant proportion reported psychiatric comorbidities: 49.6% had post-traumatic stress, 50.3% had depression, 58.2% reported anxiety, 39% had a history of suicide attempts, and 54% were smokers. Stratified analysis revealed significant associations between PNES and anxiety (p = 0.008) as well as suicide attempts (p = 0.036), whereas depression and PTSD did not show statistically significant relationships. Conclusion: PNES were observed in over half of the study population, with strong associations identified between PNES and psychiatric conditions such as anxiety and prior suicide attempts. These findings emphasize the importance of psychiatric evaluation in patients presenting with seizure-like episodes and highlight the need for interdisciplinary management strategies.

Prevalence of Thrombocytopenia Amongst Patients with Cirrhosis Presenting to Shaheed Saif Ur Rehman Government Hospital, Gilgit

2025-03-29T13:24:19+00:00

Thrombocytopenia is a common complication in patients with cirrhosis, often impacting clinical management. Understanding its frequency and associations can enhance early diagnosis and treatment strategies. Objective: To determine the frequency of thrombocytopenia among patients with cirrhosis and identify factors associated with its occurrence. Methods: A cross-sectional study was conducted after obtaining ethical approval from the Shaheed Saif-Ur-Rehman Government Teaching Hospital, Gilgit, and the CPSP (December 26, 2024, to March 26, 2025. The study included 190 patients who met the selection criteria, and written informed consent was obtained from each participant. Comprehensive physical and clinical examinations were performed, and a liver ultrasound was conducted to confirm cirrhosis. Blood samples were analyzed to assess platelet counts, with thrombocytopenia defined as a platelet count below 150,000 per cubic millimeter. A pre-designed proforma recorded demographic data, disease duration, and body mass index (BMI). Statistical analysis was performed using SPSS version 25. Results: The mean age of participants was 45.63±9.08 years, with 37.4% being above 50 years. Males represented 54.2% of the sample. The mean BMI was 26.87±3.56 kg/m², and the mean disease duration was 8.43±2.32 months. Urban residents comprised 60.0% of the sample. Monthly income distribution showed that 43.7% earned Rs. 40,000-80,000, and 35.8% earned less than Rs. 40,000. Most were from low socioeconomic backgrounds (52.1%), and 37.4% were illiterate. Thrombocytopenia was observed in 57.9% of patients, with a significant association found only with urban residence (p = 0.03). No significant associations were found with age, gender, income, or education. Conclusion: Thrombocytopenia is prevalent in more than half of cirrhotic patients, with a substantial association observed with urban residence. No significant links were found with age, gender, socioeconomic status, income, or education. Regular monitoring of platelet counts is crucial for the early detection and management of thrombocytopenia in cirrhotic patients. Further studies are needed to explore contributing factors and improve treatment strategies.