Biological and Clinical Sciences Research Journal

Work Stress in Nurses and Its Influence on Patient Care and Quality of Life

2025-02-27T08:21:50+00:00

Nurses play a critical role in patient care, but work-related stress is a prevalent concern that negatively affects their quality of life (QoL) and caring behaviors. High stress levels can lead to burnout, decreased job satisfaction, and compromised patient care. Understanding the impact of work stress on nurses’ well-being and professional performance is essential for improving healthcare outcomes. Objective: To assess the work stress in nurses and its impact on their quality of life and patient care. Methodology: A cross-sectional study was conducted in the Nursing Department of Medicare Hospital, Multan from December 2023 to December 2024. One hundred nurses with at least 1-year experience and those directly involved with patient care were selected for the study. Data was collected through a questionnaire divided into four sections; demographic details, Expanded Nurses Stress Scale, Quality of Life questionnaire, and Caring Dimension Inventory. Results: The mean stress score was 2.81 ± 0.49 with the highest score from death and dying and inadequate emotional preparation. The mean quality of life score was 57.57 ± 17.98, with better physical health core than mental health. Gender was significantly associated with quality of life with males scoring better than females. Job stress score and subsets were negatively associated with total caring behavior score. However, caring behavior was only significantly related to the total score, problems with the supervisor, intra-physician conflict, and patients and families. The variables of job stress were inversely associated with quality of life with job stress causing a 28% change in quality of life (R2adj = 0.281, p<0.001). Conclusion: There was high job stress among nurses, which negatively affected their quality of life and caring behaviors.

Comparing the Efficacy of Oral Pregabalin Premedication with Placebo on Stress Response in Patients Undergoing Laparoscopic Cholecystectomy After Creation of Pneumoperitoneum

2025-02-08T12:04:09+00:00

Hemodynamic fluctuations following pneumoperitoneum creation during laparoscopic cholecystectomy pose a challenge in anaesthesia management. Pregabalin, a gabapentinoid, has shown potential in attenuating this stress response. Objective: To compare the effects of oral pregabalin premedication with placebo on heart rate (HR) and mean arterial pressure (MAP) in patients undergoing laparoscopic cholecystectomy. Methodology: This prospective study was conducted at the Department of Anesthesiology, Nishtar Medical University and Hospital, Multan, from June 23, 2023, to December 22, 2023. Sixty patients were randomly assigned to two groups: Group A received 150 mg of oral pregabalin one hour before general anaesthesia, while Group B received a placebo. Standard intraoperative monitoring was used, and HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP were recorded. Data were analysed using SPSS version 27, and an independent sample t-test was used to compare hemodynamic parameters between the two groups, with a significance level of p<0.05. Results: After five minutes of pneumoperitoneum creation, Group A had significantly lower HR (78.23 ± 5.03 bpm vs. 87.50 ± 5.73 bpm, p<0.001), MAP (91.73 ± 5.06 mmHg vs. 100.79 ± 5.33 mmHg, p<0.001), SBP (121.20 ± 8.34 mmHg vs. 131.57 ± 8.59 mmHg, p<0.001), and DBP (77.00 ± 5.64 mmHg vs. 85.40 ± 5.33 mmHg, p<0.001) compared to Group B. Conclusion: Oral pregabalin premedication effectively attenuates the hemodynamic stress response following pneumoperitoneum creation in laparoscopic cholecystectomy. Its use as a premedication can enhance perioperative hemodynamic stability.

Frequency of Stroke and Factors Leading to It in Old Age Patients With Hypertension

2025-02-22T16:44:46+00:00

Stroke is a major cause of disability and mortality among hypertensive elderly patients. Understanding its frequency and associated risk factors is crucial for prevention and management. Objective: This study aimed to determine the frequency of stroke and identify associated risk factors among hypertensive old aged patients. Methodology: A cross-sectional study was conducted at a tertiary care hospital over six months. Participants included 150 hypertensive patients (86 males, 64 females) with a mean age of 57.4 ± 7.1 years. Data were collected through structured interviews and medical record reviews, capturing sociodemographic details, behavioural factors (smoking), clinical history (diabetes, cardiovascular disease, dyslipidemia, prior stroke), and physical measurements (BMI, blood pressure). Stroke diagnosis was confirmed using WHO criteria, supported by clinical and imaging evidence. Descriptive statistics and logistic regression were used for analysis, with significance set at p < 0.05. Results: The frequency of stroke was 10.7% (n=16). Stroke cases were more prevalent in individuals over 60 years (81.2%), males (75.0%), smokers (56.2%), and those with obesity (56.2%). Comorbid conditions such as diabetes (50.0%) and dyslipidemia (50.0%) were significantly higher in stroke patients compared to non-stroke cases (20.1% and 23.1%, respectively). A family history of stroke was reported in 43.8% of stroke patients, compared to 8.2% in non-stroke participants. Conclusion: Stroke remains a significant health concern among hypertensive patients, with a prevalence of 10.7%. Key risk factors include advanced age, male gender, smoking, obesity, and comorbid conditions such as diabetes and dyslipidemia. These findings underscore the need for targeted interventions, including smoking cessation programs, weight management strategies, and stricter control of metabolic conditions. Routine screening and public health education should be prioritized to mitigate stroke risk in this vulnerable population.

Role of APACHE-II Score in Predicting The Incidence of Ventilator-Associated Pneumonia in Intensive Care Unit Patients

2024-11-30T18:29:28+00:00

A prevalent nosocomial infection in the intensive care unit (ICU) is ventilator-associated pneumonia (VAP). VAP is defined as pneumonia in individuals with invasive mechanical ventilation during the preceding 48 hours; it affects 5–40% of patients with invasive mechanical ventilation. These scoring systems forecast the mortality, hence the disease’s prognosis, which is very important in limited health resources and an increased cost of health management. ICU staff and doctors are highly recommended to be familiar with using the APACHE-II scoring system. The three main components of the APACHE-II score are Acute Physiology scores (APS), age scores, and chronic health scores, generating a score from 0 to 71. These 12 measurements are measured within 24 hours of ICU admission. APACHE-II shows a better prediction of hospital outcomes than SAPS-II. So, the APACHE-II score can be used as an ICU standard. A study by Sutiono et al. in Indonesia stated that an APACHE-II score greater than 15 is linked with a higher risk of VAP. Objective: To see the APACHE-II score’s role in predicting ventilator-associated pneumonia incidence. Methods: This is a retrospective Cross-sectional Study done at the surgical ICU of Doctors Hospital and Medical Centre, Lahore, Pakistan, during the 18 months from 1st January 2022 to 30th June 2023. After the Approval to conduct this study was obtained from the hospital’s ethical committee (can be presented on request), data were collected manually and filled in tables in a Microsoft Office Word Document. Data was presented in the form of frequency (Percentages). Exclusion criteria for this study were patients aged less than 16 years, with a stay of less than 24 hours, and those who did not have all 19 physiological parameters. All patients over 16 years who stayed in the ICU for more than 24 hours were included in this study. Results: 293 patients were put on mechanical ventilation in the Surgical I.C.U. of Doctors Hospital and Medical Centre over the study period. Out of these 293 patients who were put on mechanical ventilation, 46 (15.69%) patients developed ventilator-associated pneumonia (VAP). Of 46 patients, 31 (67.4%) survived, and 15 (32.6%) expired. The prevalence of micro-organisms causing VAP is as follows: Pseudomonas 11(23.9%), Klebsiella 10 (21.7%), Acinetobacter 9 (19.5%), Candida albicans 6 (13%), Burkholderia 3 (6.5%), Staphylococcus 3 (6.5%), E. coli 2 (4.34%), Proteus mirabilis 1 (2.2%) and Enterobacter cloacae 1 (2.2%). Patients are then divided into two groups (those with APACHE-II score <20 and those with APACHE-II Score >20) to see the correlation between APACHE-II and VAP incidence. Patients with APACHE-II scores of more than 20 are 90 (30.7%), and 203 patients have less than 20. Of the group with APACHE Score <20, 18 (8.86%) developed VAP, and of the group with APACHE-II Score >20, 28 patients (31%) had developed VAP. Conclusion: The APACHE-II Scoring system is a good predictor of Ventilator-associated Pneumonia in intensive care unit settings. An APACHE-II score of more than 20 is a higher risk of developing ventilator-associated pneumonia than patients with an APACHE-II score of less than 20.

Deciphering the Relationship Between Janus Kinase -2 (Jak-2) Mutation and Thrombocytopenia

2025-02-17T16:07:53+00:00

Hematological parameters, including white blood cells (WBCs), haemoglobin (HB), hematocrit (HCT), and platelet (PLT) levels, play a crucial role in assessing overall health and disease conditions. Understanding their relationships with various influencing factors is essential for refining diagnostic and prognostic evaluations. Objective: This study aimed to explore the relationships between various haematological parameters, including white blood cells (WBCs), haemoglobin (HB), hematocrit (HCT), and platelet (PLT) levels, and their respective influencing factors. The correlation coefficients (r-values) and p-values were analyzed to determine the strength and statistical significance of these associations. Methods: A correlation analysis was conducted on the haematological parameters. The R-values were calculated to assess the strength and direction of relationships, while the p-values determined the statistical significance. The parameters studied included WBC, HB, HCT, and PLT. The duration of the study was from April 2024 to September 2024. Results: - WBC analysis yielded an R-value of 0.05 and a p-value of 0.034, indicating a positive correlation with statistical significance.- HB analysis showed an r-value of -0.055 and a p-value of 0.604, reflecting a negative correlation that was not statistically significant. - HCT analysis that was also not statistically significant. - PLT analysis produced an R-value of 0.037 and a p-value of 0.727, indicating a negative correlation that was also not statistically significant. Conclusion: The analysis revealed that while the WBCs and AGE showed a statistically significant positive correlation, the other parameters—HB, HCT, and PLT—did not exhibit statistically significant correlations with the variables studied. These findings suggest that the factors investigated have minimal or no meaningful impact on the haematological parameters, warranting further research to identify more significant associations.

Frequency of left ventricular systolic dysfunction in patients receiving Primary Percutaneous intervention vs Delayed Percutaneous intervention presenting with ST- Elevation Myocardial infarction

2025-02-13T07:56:41+00:00

Left ventricular systolic dysfunction (LVSD) is a significant complication following ST-elevation myocardial infarction (STEMI), associated with an increased risk of heart failure and long-term cardiovascular mortality. Primary percutaneous coronary intervention (PPCI) is the gold-standard treatment for STEMI, yet delayed PCI remains common in Pakistan due to limited healthcare accessibility and delayed patient presentation. This study compares the frequency of LVSD in STEMI patients undergoing PPCI versus delayed PCI at a tertiary care hospital in Lahore, Pakistan. Objective: To evaluate and compare LV systolic function in STEMI patients who underwent early PPCI versus delayed PCI, determining the impact of PCI timing on left ventricular ejection fraction (LVEF) and overall cardiac function. Methods: A prospective observational study was conducted at the Cardiology Department, Punjab Institute of Cardiology Lahore. One hundred sixty patients were enrolled and stratified into PPCI (n=80) and delayed PCI (n=80). Baseline demographics, comorbidities (hypertension, diabetes, dyslipidemia, smoking), and echocardiographic findings (LVEF, LVSD) were recorded. LVSD was defined as LVEF <40% at hospital discharge. Data were analysed using SPSS version 26, with chi-square and independent t-tests for statistical comparisons, considering p ≤ 0.05 statistically significant. Results: The overall prevalence of LVSD was 43.1%, with a significantly higher incidence in delayed PCI patients (57.5%) compared to PPCI patients (28.7%) (p < 0.001). Patients in the PPCI group had significantly higher LVEF at discharge (50.3% ± 7.2) compared to the delayed PCI group (42.1% ± 6.8, p < 0.05). Dyslipidemia (p = 0.001) was significantly associated with LVSD, whereas diabetes mellitus showed a borderline association (p = 0.06). Other risk factors, including hypertension and smoking, were not statistically significant predictors of LVSD. Conclusion: Early PCI significantly reduces the incidence of LV systolic dysfunction in STEMI patients, reinforcing the importance of timely reperfusion therapy to prevent long-term myocardial damage. Delays in PCI were associated with larger infarct size, lower LVEF, and a higher prevalence of LV dysfunction. Given the high burden of STEMI and PCI delays in Pakistan, healthcare policies should prioritise expanding PPCI-capable centres, improving emergency medical services (EMS), and raising awareness of early STEMI symptoms to enhance patient outcomes.

Frequency of endophthalmitis following intravitreal bevacizumab injection using povidone-iodine vs povidone-iodine with topical antibiotics as prophylaxis in patients of macular oedema

2025-02-12T19:37:37+00:00

This study compared povidone-iodine alone versus povidone-iodine with antibiotics to prevent endophthalmitis after intravitreal bevacizumab injections for macular oedema. It aimed to find the best infection prevention method. Objective: To determine the efficacy of per-operative 5% povidone-iodine alone vs combined per-operative 5% povidone-iodine with topical antibiotics for reducing the frequency of endophthalmitis in patients undergoing repeated intravitreal injection of Anti-VEGF (Bevacizumab). Methods: This randomised control trial was conducted at the Department of Ophthalmology, Sir Ganga Ram Hospital, Lahore. Patients meeting inclusion criteria were enrolled after taking informed written consents, and two equal groups were made on a random basis using a lottery method: Group A (Povidone Iodine Alone) and Group B (Povidone Iodine with Topical Antibiotics). The procedure was performed per the hospital's standard protocol, and variables were noted for data analysis. Results: The mean age was 51.23±12.43 years, with a balanced gender ratio (52.6% male, 47.4% female). Injections were predominantly in the right eye (52.9%) versus the left (47.1%). Diabetic macular oedema (57.4%) was most prevalent, followed by choroidal neovascularization (17.1%), central retinal vein occlusion (8.9%), branch retinal vein occlusion (10.9%), and other pathologies (5.7%). Groups A and B had similar baseline characteristics (p>0.05). Both groups had a 0.6% endophthalmitis rate (p=1.000), each with 175 patients. Conclusion: This study comparing 5% povidone-iodine alone versus 5% povidone-iodine with topical antibiotics for prophylaxis during intravitreal bevacizumab injections did not demonstrate a significant difference in the incidence of endophthalmitis between the two groups.

Outcome of Kangaroo Mother Care and Conventional Method of Care

2025-02-11T17:48:21+00:00

The care provided to newborns, particularly preterm, low-birth-weight (LBW), and medically fragile infants, is a critical aspect of neonatal healthcare. Objective: The primary purpose of the study is to find the outcome of kangaroo mother care and conventional care methods. Methods: This randomised control trial was conducted at the Paediatric Department of Lyari General Hospital Karachi from September 2024 to February 2025. A total of 60 patients were included in the study, with 30 infants in each group—one group receiving Kangaroo Mother Care and the other receiving conventional care methods. Infants who were born preterm (before 37 weeks of gestation) or had low birth weight (less than 2500 grams) were included in the study. Infants with major congenital anomalies or those requiring surgical interventions were excluded. Results: Data were collected from 60 participants. There were no significant differences between the two groups across various characteristics: gender (15/15 male/female in KMC vs 16/14 in Conventional Care, p=0.87), mean gestational age (32.5 ± 2.1 weeks in KMC vs 32.3 ± 2.3 weeks in Conventional Care, p=0.78), mean birth weight (1800 ± 300 grams in KMC vs 1750 ± 350 grams in Conventional Care, p=0.65), age at enrollment (12 ± 4 hours in KMC vs 12 ± 5 hours in Conventional Care, p=0.96), maternal age (28.5 ± 4.2 years in KMC vs 29.2 ± 4.5 years in Conventional Care, p=0.56), mode of delivery (18/12 C-section/vaginal in KMC vs. 17/13 in Conventional Care, p=0.80), APGAR score at 5 minutes (7.2 ± 1.1 in KMC vs. 7.4 ± 1.2 in Conventional Care, p=0.42), and maternal health conditions (2 (6.7%) in KMC vs. 3 (10%) in Conventional Care, p=0.73). Conclusion: It is concluded that Kangaroo Mother Care (KMC) offers significant benefits over conventional neonatal care for preterm and low-birth-weight infants, including improved weight gain, better thermoregulation, reduced infection rates, and enhanced breastfeeding success.

Comparison of Surgical Site Infection in Diabetic vs. non-diabetic Patients Operated Electively in the Surgical Unit of MTI-Lady Reading Hospital Peshawar

2025-02-11T15:49:19+00:00

Surgical site infections (SSIs) are a major cause of postoperative morbidity, prolonged hospital stays, and increased healthcare costs. Patients with diabetes mellitus are at a higher risk of developing SSIs due to impaired immune responses and delayed wound healing. Understanding the impact of diabetes on SSIs in elective surgeries is crucial for improving perioperative care and patient outcomes. Objective: To compare the incidence of surgical site infections (SSIs) between diabetic and non-diabetic patients undergoing elective surgeries in a surgical unit and to evaluate associated factors influencing infection rates. Methods: This comparative cross-sectional study included 70 patients aged 25 years and above, divided equally into two groups: 35 diabetic patients (Group A) and 35 non-diabetic patients (Group B). The patients underwent elective, open and laparoscopy surgeries with similar perioperative care protocols, including standardised antibiotic prophylaxis. SSIs were identified based on clinical criteria, including purulent discharge, erythema, swelling, fever, and elevated white blood cell counts. Patients were followed for 30 days postoperatively to record infection outcomes. Results: The incidence of SSIs was notably higher in diabetic patients, with 42.9% (n=15) developing infections, compared to 17.1% (n=6) in non-diabetic patients (p<0.05). Demographic characteristics, including age and BMI, were comparable between the two groups. Comorbidities such as obesity and hypertension were more prevalent in diabetic patients, potentially contributing to the increased risk of SSIs. Among the surgical approaches, laparoscopic procedures were more common in both groups, yet the infection rates remained disproportionately higher in the diabetic cohort. Conclusion: Diabetes is a significant independent risk factor for SSIs, even in elective surgical procedures. The findings underscore the need for optimised glycemic control, management of comorbid conditions, and stringent perioperative infection prevention measures to improve surgical outcomes in diabetic patients.

Challenges and Barriers in Implementing Community Health Education Faced by BSN Students at the College of Nursing, Sir C.J Institute of Psychiatry, Hyderabad

2025-02-27T13:26:08+00:00

Health education empowers individuals to enhance their health knowledge and make health-related decisions. Objective: This research aimed to assess the challenges and barriers BSN students face in implementing community health education. Methods: The descriptive non-experimental design was the research methodology employed in this study from September 17 to December 23, 2024. The study was conducted with 106 BSN students from the College of Nursing at Sir C.J. Institute of Psychiatry, Hyderabad. A structured questionnaire was utilised to identify the challenges and barriers to health education. In IBM SPSS version 23, descriptive statistics were used to analyse the data as frequencies and percentages. Results: Major challenges included managing diverse client groups, preparing appropriate audiovisual aids, addressing clients’ time limitations, finding suitable session venues, and balancing additional clinical assignments. Significant barriers were identified, such as difficulties translating medical terminology into the local language, noise, environmental distractions, challenges in controlling external factors, and insufficient time to evaluate the client’s knowledge effectively. Conclusion: The study concluded that BSN students encounter various challenges and barriers in delivering health education, relating to students, teaching materials, audiovisual aids, clients, environmental factors, and evaluation processes. Identifying these challenges is essential for developing strategies to overcome them, ultimately facilitating more effective health education in community settings.

Knowledge and Attitudes of Nursing Students About Opioids and Overdose Crisis

2025-02-09T12:31:21+00:00

Adequate knowledge and positive attitudes toward opioids are crucial for nursing students to provide effective pain management while minimizing the risk of opioid misuse. Understanding students’ perspectives on opioid use and overdose can help improve nursing education and patient care. Objective: To assess the knowledge and attitudes of nursing students regarding opioids and opioid overdose. Methodology: This cross-sectional study was conducted at Medicare Hospital of Nursing, Multan, from December 2023 to December 2024. A total of 100 full-time nursing students were selected. Data were collected through a 34-item questionnaire assessing demographic characteristics, knowledge, attitudes toward opioids and overdose, experience with pain management, and satisfaction with opioid policies. Responses were recorded on a Likert scale ranging from 0 (strongly disagree) to 5 (strongly agree). Statistical analysis was performed to compare knowledge and attitude scores across different academic years. Results: The mean knowledge score increased significantly with the student's educational progression, from 11.2 ± 2.76 in first-year students to 17.1 ± 2.58 in fourth-year students (f(df3) = 21.34, p<0.001). Attitudes toward opioids were negative in 50% of students overall, but this percentage declined with academic advancement: 82% of first-year, 60% of second-year, 44.5% of third-year, and 40% of fourth-year students had negative attitudes. Conclusion: Nursing students demonstrated satisfactory knowledge and a moderate attitude toward opioids, with both improving as they progressed through their academic years. However, curriculum enhancement and hands-on clinical experiences are essential to refine their understanding further and promote better patient care.

Study of Complications Associated With Acute Anterior Wall MI Presenting at a Tertiary Care Hospital

2025-02-23T08:36:57+00:00

Acute Anterior Wall Myocardial Infarction (AWMI) is a severe type of MI that frequently results in life-threatening complications and has a high morbidity and death rate. Objective: This study aims to assess the prevalence and types of complications associated with AWMI in patients admitted to tertiary care Hospitals in Quetta. Methodology: In a tertiary care hospital in Quetta, Pakistan, 200 AWMI patients participated in a qualitative study. Semi-structured interviews were used to gather data, and content analysis was used for analysis. Results: Twenty-four percent of patients had cardiogenic shock, and forty percent had arrhythmias, the most prevalent of which were atrial fibrillation (11%) and ventricular tachycardia (15%). 35% of patients experienced mechanical problems, most common being ventricular thrombus left (10%) and mitral regurgitation (15%). Conclusion: Significant consequences from AWMI necessitate early identification and treatment. Through effective treatment plans and ongoing monitoring, tertiary care facilities significantly contribute to better patient outcomes.

Work Stress, Burnout, and Patient Satisfaction Towards Nurses Working in Medicare Hospital, Multan

2025-02-07T12:05:53+00:00

Nurse burnout and work-related stress are critical factors that can influence patient care quality. Understanding their impact on patient satisfaction, particularly in high-pressure settings like emergency departments, is essential for improving healthcare outcomes. Objective: To assess the association between burnout and work stress in nurses with patient satisfaction in the emergency department. Methodology: A cross-sectional study was conducted in the Emergency Department of Medicare Hospital, Multan, from December 2023 to December 2024. A total of 100 nurses working in the emergency department for at least 1 year were included in the study. Study data was collected through questionnaires. A 22-item Nursing Stress Scale was used to assess work stress through incidences in the workspace. A 16-item Maslach Burnout Inventory-General Services Scale was used to evaluate burnout in nurses. The questionnaire was divided into three sections: emotional exhaustion, cynicism, and personal effectiveness. Patient satisfaction was measured on a 12-item La Mónica-Oberst Patient Satisfaction Scale presented to emergency department patients after 1-2 days of admission. Results: No significant associations were observed between demographic and professional parameters, stress, burnout, and patient satisfaction. The mean satisfaction score was 4.71 ± 0.93, showing an adequate positive perception among patients. The mean nurse stress score was 0.99 ± 0.10, emotional exhaustion score was 2.02 ± 0.28, cynicism score was 1.49 ± 0.21, and personal effectiveness score was 5.08 ± 0.30, indicating low stress, exhaustion, and cynicism which lead to high performance. Only 5% of the nurses experienced burnout, which was associated with stress experienced at work. However, patient satisfaction was not associated with burnout or stress levels of nurses. Conclusion: Stress and burnout parameters of nurses were not significantly associated with patient satisfaction. However, further research is needed in this field.

Effectiveness of Knotless Suture as A Wound Closure Agent for Impacted Third Molar

2025-02-18T12:02:44+00:00

Impacted third molar extraction is a common surgical procedure performed by oral and maxillofacial surgeons, often requiring effective wound closure techniques. Conventional sutures have been widely used; however, knotless sutures have emerged as an alternative method, potentially offering faster wound closure and reduced post-operative complications. This study evaluates the effectiveness of knotless sutures as a wound closure agent compared to conventional sutures in impacted third-molar surgeries in the Pakistani population. Objective: To compare the outcomes of knotless sutures versus conventional sutures regarding wound closure time and post-operative swelling in impacted third-molar surgeries. Methods: A randomized controlled trial was conducted at the Department of Oral & Maxillofacial Surgery, Dr. Ishrat Ul Ebad Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan. 72 patients undergoing impacted third molar extraction were randomly allocated into Group A (knotless sutures) and Group B (conventional sutures), with 36 patients in each group. Primary outcomes included wound closure time (measured in minutes) and post-operative swelling (measured in millimeters) at 1-hour and 72-hour intervals. Data were analyzed using SPSS version 23, and statistical significance was set at p≤0.05. Results: The mean age of participants was 26.14 ± 4.66 years in Group A and 24.50 ± 4.39 years in Group B. Mean wound closure time in Group A was significantly lower (2.78 ± 0.90 minutes) compared to Group B (4.47 ± 1.30 minutes, p=0.0001). Swelling at 1 hour post-operatively was significantly lower in Group A (42.69 ± 4.82 mm) than in Group B (46.22 ± 4.46 mm, p=0.002). Similarly, at 72 hours, swelling was lower in Group A (34.75 ± 4.80 mm) compared to Group B (40.80 ± 6.56 mm, p=0.0001). Conclusion: Knotless sutures improved wound closure efficiency and reduced post-operative swelling compared to conventional sutures in impacted third-molar surgeries. These findings support adopting knotless suturing techniques in oral surgical procedures to enhance clinical outcomes and patient comfort.

Frequency of Molar-Incisor Hypomineralization in Children Visiting Department of Operative Dentistry & Endodontics at Hamdard University Dental Hospital Karachi

2025-02-17T13:55:59+00:00

Molar-incisor hypomineralization (MIH) is a prevalent developmental dental condition affecting the first permanent molars and incisors, leading to enamel defects, hypersensitivity, and increased risk of dental caries. Early detection is essential for timely management and prevention of complications. Objective: To determine the frequency of molar-incisor hypomineralization (MIH) in children visiting the Department of Operative Dentistry & Endodontics at Hamdard University Dental Hospital Karachi with complain of pain & sensitivity. Methodology: This cross-sectional study was conducted over six months and included 180 children presenting with complaints of pain, sensitivity, discoloration, or caries in one or more first permanent molars with or without involvement of incisors. Participants were selected using consecutive sampling. The diagnosis of MIH was based on criteria set by the European Academy of Paediatric Dentistry (EAPD). It included clinical examination for demarcated opacities, post-eruptive enamel breakdown, atypical restorations, and extractions of first permanent molars. Informed consent and assent were obtained from participants and their guardians. Data analysis was performed using SPSS Version 23, with quantitative data summarized as means and standard deviations and qualitative data as frequencies and percentages. Chi-square and Fisher’s exact tests were used for associations, with significance set at p ≤ 0.05. Results: The mean age of participants was 11.66 ± 2.73 years. The prevalence of MIH was 3.9%. Demarcated opacities were observed in 2.8% of participants, post-eruptive enamel breakdown in 2.2%, atypical restorations in 1.7%, and extractions of first permanent molars in 1.7%. MIH was more common in females (71.4%) than males (28.6%), and 85.7% of cases occurred in the 8–12-year age group. However, no significant associations were found between MIH and age or gender. Conclusion: The study highlights a low prevalence of MIH in the local population, with most cases occurring in younger children. Early diagnosis and intervention are crucial to managing this condition effectively and preventing long-term complications.

Efficacy of Dexmedetomidine Versus Midazolam For Early Extubation in Critically Ill Agitated Patients Undergoing Weaning Introduction

2025-02-13T15:08:08+00:00

Effective sedation is essential for weaning and extubation in critically ill patients. Dexmedetomidine and midazolam are commonly used sedatives in intensive care units (ICUs). While dexmedetomidine has shown advantages in terms of sedation quality and hemodynamic stability, comparative data in the Pakistani ICU setting remains limited. Objective: To compare the efficacy and safety of dexmedetomidine and midazolam for sedation during weaning and early extubation in critically ill, agitated patients in the ICU. Methods: This prospective randomized controlled trial was conducted at Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. A total of 60 patients were randomized into two groups: Group D (dexmedetomidine, n=30) and Group M (midazolam, n=30). Sedation was titrated to achieve target Ramsay Sedation Scale (RSS) scores of 3–4. Time to extubation, sedation quality, hemodynamic parameters, and adverse events were recorded. Statistical analysis was performed using SPSS version 26, with a p-value ≤0.05 considered significant. Results: The mean time to extubation was significantly shorter in Group D (21.4 ± 5.6 hours) compared to Group M (30.8 ± 8.3 hours, p<0.001). Sedation quality, measured using RSS, was superior in Group D, with higher scores at 6 hours (4.7 ± 0.4 vs. 3.9 ± 0.6, p<0.001). Hemodynamic stability was better in Group D, with a lower mean heart rate (76.4 ± 8.1 beats/min vs. 84.5 ± 9.3 beats/min, p=0.012) and higher mean arterial pressure (85.2 ± 6.4 mmHg vs. 80.8 ± 5.9 mmHg, p=0.026). Adverse events, including bradycardia (23.3% vs. 10%) was higher in group D and oxygen desaturation (3.3% vs. 10%), were lower in Group D, though differences were not statistically significant. Conclusion: Dexmedetomidine demonstrated superior sedation quality, faster extubation, and better hemodynamic stability compared to midazolam, with minimal adverse events. These findings support dexmedetomidine as a safer and more effective alternative for sedation during weaning in critically ill patients. Further research is warranted to validate these findings and assess cost-effectiveness in resource-limited settings.

Pudendal Nerve Block with Bupivacaine Vs Bupivacaine Plus Steroid on Reducing Perianal Pain After Hemorrhoidectomy

2025-02-13T06:29:40+00:00

Postoperative pain management in hemorrhoidectomy remains a clinical challenge, with pudendal nerve block (PNB) emerging as an effective technique. Adding steroids to local anaesthetics may enhance analgesic efficacy and prolong pain relief. Objective: To compare the effectiveness of pudendal nerve block (PNB) using bupivacaine alone versus bupivacaine with dexamethasone in reducing perianal pain following hemorrhoidectomy. Methods: A prospective study was conducted at the Department of General Surgery, University of Lahore Teaching Hospital, Lahore, from July 31, 2024, to January 30, 2025. A total of 60 patients undergoing hemorrhoidectomy were randomly assigned into two groups: Group A (n=30) received PNB with 20 mL bupivacaine. Group B (n=30) received PNB with 20 mL bupivacaine and 8 mg dexamethasone. The blocks were performed bilaterally under spinal anaesthesia using anatomical landmarks. All patients received standard postoperative analgesia. Pain scores were recorded at 12 and 24 hours postoperatively using the Visual Analog Scale (VAS). Group comparisons were conducted using the t-test, with statistical significance at p ≤ 0.05. Results: The mean pain score at 12 hours postoperatively was significantly lower in Group B (1.90 ± 0.481) compared to Group A (2.47 ± 0.681), with a p-value of 0.001, indicating a statistically significant difference in pain relief. The addition of dexamethasone resulted in enhanced and prolonged analgesia without increasing adverse effects. Conclusion: The use of PNB with bupivacaine plus dexamethasone significantly reduces postoperative perianal pain after hemorrhoidectomy compared to bupivacaine alone. This combination provides superior analgesic efficacy and can be considered a safe and effective technique for pain management in perianal surgeries.

Frequency of Factors Leading To Intrapartum Perineal Tears in Primigravida

2025-02-11T18:26:33+00:00

Intrapartum perineal tears are common complications during childbirth, particularly in primigravida women. Several factors, including episiotomy, vacuum-assisted delivery, and fetal macrosomia, influence the occurrence of these tears. This study aimed to evaluate the frequency and associated factors leading to intrapartum perineal tears in primigravida women in a hospital setting in Peshawar, Pakistan. Objective: To evaluate the frequency and associated factors leading to intrapartum perineal tears in primigravida women in a hospital setting in Peshawar, Pakistan Methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Hayatabad Medical Complex, Peshawar, from 15th January 2021 to 15th July 2021. A total of 123 primigravida women with singleton pregnancies were included in the study. The sample size was calculated using the WHO sample size calculator with a 95% confidence interval and a 7% margin of error. Participants were selected using non-probability consecutive sampling. Demographic data and information on episiotomy, vacuum delivery, and macrosomia were collected through a structured proforma. Data were analyzed using SPSS version 22, and descriptive statistics and chi-square tests were used to identify associations. Results: The mean age of participants was 27.1 ± 2.45 years, with a mean gestational age of 38.6 ± 1.28 weeks and a mean weight of 68.5 ± 5.97 kg. Episiotomy was performed in 21.1% of cases, vacuum delivery in 29.3%, and macrosomia was observed in 32.5% of the participants. Stratification of episiotomy, vacuum delivery, and macrosomia by age, gestational age, and weight revealed no significant associations (p-value >0.05). The episiotomy rate was higher in women weighing ≤70 kg (24.7%) and those aged 18–30 years (23.7%). Vacuum delivery was more common in younger women (29.7%) and in those weighing >70 kg (36.7%). Conclusion: Episiotomy, vacuum delivery, and macrosomia were identified as key factors associated with intrapartum perineal tears in primigravida women. The findings suggest that variations in obstetric practices, maternal weight, and fetal characteristics play a significant role in the incidence of perineal tears. Further studies are needed to standardize practices such as episiotomy and vacuum extraction and to assess their impact on perineal trauma in diverse populations.

Effectiveness of Intralesional Steroid Injections in Peyronie’s Disease

2025-02-11T16:42:20+00:00

Peyronie’s disease (PD) is a progressive fibrotic disorder characterised by penile curvature, plaque formation, pain, and erectile dysfunction, significantly impacting patients' quality of life. Various treatment modalities, including intralesional steroid injections, have been explored to manage PD, but their efficacy remains a subject of investigation. Objective: This observational study aimed to evaluate the effectiveness of intralesional steroid injections in treating Peyronie’s disease. Methods: This observational study was conducted from January 2023 to December 2024, involving 101 male patients aged between 20 and 65. All patients were diagnosed with Peyronie’s disease based on clinical evaluation and medical history. Participants were treated with intralesional steroid injections administered every four weeks for a total of three sessions. Pre- and post-treatment assessments included measurements of penile curvature, plaque size, erectile function using the International Index of Erectile Function (IIEF), and pain levels using a visual analogue scale (VAS). The primary outcomes were changes in penile curvature, erectile function, plaque size and pain relief, with follow-up evaluations conducted after each treatment cycle. Results: Out of the 101 patients, 75.2% experienced improvements in penile curvature, and 61.4% showed a reduction in plaque size. Additionally, 64.4% of participants reported pain relief, and 77.2% exhibited improvements in erectile function, as measured by the IIEF score. Conclusion: Intralesional steroid injections were found to be effective in reducing penile curvature, plaque size, and pain, as well as improving erectile function in patients with Peyronie’s disease.

Clinico-Hematological Spectrum of Non-Leukemic Myeloproliferative Disorder

2025-02-27T17:11:11+00:00

Myeloproliferative neoplasms (MPNs) are a group of hematological disorders originating from marrow stem cells, characterised by clonal proliferation of hematopoietic components. The three primary non-leukemic MPNs include Polycythemia Vera (PV), Essential Thrombocythemia (ET), and Primary Myelofibrosis (PMF). These disorders affect the bone marrow, liver, and spleen, leading to various clinical manifestations. Limited data on MPNs in Pakistan necessitates further research to understand their prevalence and demographic distribution. Objective: To assess the spectrum, prevalence, and demographic distribution of non-leukemic MPNs among patients at Benazir Bhutto Hospital, Rawalpindi. Methodology: A retrospective study was conducted over three to four months at Benazir Bhutto Hospital, Rawalpindi. Patient data were analysed using SPSS Version 25, focusing on categorical variables such as age, gender, and MPN type. The diagnosis of MPNs was based on clinical, hematological, and cytogenetic criteria by the 2016 WHO classification. Results: 26 patients were diagnosed with non-leukemic MPNs, with a male-to-female ratio of 1.4:1. Among these, 15 males (58%) and 11 females (42%) were affected. Polycythemia Vera was diagnosed in 7 patients (27%), Essential Thrombocythemia in 9 patients (35%), and Primary Myelofibrosis in 7 patients (27%). Three patients (11%) were classified as MPN-Unclassified. Conclusion: The study highlights the demographic distribution and prevalence of non-leukemic MPNs in a tertiary care hospital in Pakistan. These findings emphasise the need for clinical and hematological evaluations and cytogenetic testing for accurate diagnosis. Further genetic and environmental studies are required to explore regional MPN prevalence and pathogenesis variations.

A Quality Improvement Project on Evaluating factors for Cancellation of Ophthalmic surgery.

2025-02-10T14:48:48+00:00

Ongoing challenges with surgery cancellations impose pressure on the healthcare system, necessitating systematic reforms to enhance efficiency, resource allocation, and patient care. Consequently, this audit aimed to assess the extent of cancelled cases and identify the underlying causes for their cancellation in a tertiary care hospital. Objective: To assess the frequency of cancelled surgical cases and identify the contributing factors in a tertiary care hospital. Methods: This study was carried out from January 1, 2023, to December 31, 2023, over two sessions. During this timeframe, a comprehensive census was conducted of all cases on the operating theatre (OT) list. Data from both sessions were collected using a structured proforma and analysed with SPSS version 23. Results: 81 (11.80%) cancellations were recorded from the total cases on the OT list. The median age with the interquartile range was 27 (52.5) years. In the first cycle, 17 (43.6%) of the cancellations occurred due to medical reasons, 15 (38.5%) did not show up, 1 (2.6%) experienced a change in plan, and no case was cancelled due to equipment malfunction. In the second cycle, out of the cancelled cases, approximately 17 (40.5%) were due to medical reasons, 6 (14.3%) did not show up, 08 (19%) experienced a change in plan, and 2 (4.8%) was due to equipment failure, with a statistically significant difference noted between the reasons in the first and second cycles (p=0.01). Conclusion: This study indicates that many of the factors contributing to the cancellation of surgeries are preventable, and adhering to guidelines can substantially decrease the number of cancelled cases.

Surgical Site Infections is the Concerning Issue in Pakistan: A Review Article

2025-02-13T15:37:01+00:00

Surgical Site Infections (SSIs) are a significant healthcare-associated infection, particularly in low- and middle-income countries (LMICs) like Pakistan. This review article evaluates the incidence, prevalence, risk factors and role of medical devices in surgical site infections. A literature review was conducted to assess the incidence, risk factors, and preventive strategies for SSIs. Studies comparing povidone-iodine (PI) and chlorhexidine gluconate (CHG) for skin antisepsis, normothermia and data on the effectiveness of sterile surgical attire and negative pressure wound therapy were analysed. SSI rates in LMICs range from 8-30%, compared to 1-4% in high-income countries. Risk factors include patient-related variables (e.g., malnutrition, immunosuppression), surgical factors (e.g., contamination, poor sterilisation), and physiological factors (e.g., postoperative hypoxia). CHG combined with alcohol-based preparations is more effective than PI. Maintaining normothermia, proper sterilisation, and using disposable medical equipment can reduce SSI rates. Preventive strategies include training on CHG use, mandatory disposable sterile drapes and gowns, adherence to AST and AORN guidelines for surgical attire, and continuous education for perioperative staff. Implementing comprehensive CHG combined with alcohol-based preparations, normothermia, negative pressure wound therapy, ongoing education programs, and robust preventive strategies are essential to reduce SSIs, especially in LMICs, improving patient outcomes and healthcare sustainability.