Biological and Clinical Sciences Research Journal

Comparison of Subcutaneous Infiltration With Intraperitoneal Instillation of Bupivacaine in Reduction of Early Postoperative Pain After Laparoscopic Cholecystectomy

2025-04-16T11:52:53+00:00

Postoperative pain remains a significant concern following laparoscopic cholecystectomy. Bupivacaine, a long-acting local anesthetic, is commonly used through different administration routes to reduce early postoperative pain. Determining the most effective delivery method may enhance recovery and improve patient comfort. Objective: To compare the effectiveness of subcutaneous infiltration versus intraperitoneal instillation of bupivacaine in reducing early postoperative pain following laparoscopic cholecystectomy. Methods: A quasi-experimental study was conducted at the Department of General Surgery, Qazi Hussain Ahmad Medical Complex, Nowshera, from December 2022 to June 2023. Sixty-two patients meeting the inclusion criteria were randomly assigned to two equal groups. Group A received 20 ml of 0.25% bupivacaine via subcutaneous infiltration at port sites, while Group B received the same dose intraperitoneally before the completion of the procedure. Pain intensity was assessed at 1, 4, 8, 12, and 24 hours postoperatively using the Visual Analogue Scale (VAS). Data were analyzed using SPSS Version 25, with p-values ≤0.05 considered statistically significant. Results: The mean age of participants was 45.92 ± 8.73 years. Gender distribution included 30 (51.6%) males and 32 (48.4%) females. No significant differences in age (p = 0.31) or gender (p = 0.22) were observed between groups. At 1 hour postoperatively, Group A had a higher mean VAS score (7.45 ± 0.89) compared to Group B (5.64 ± 0.84) (p = 0.00). At 24 hours, pain scores remained significantly lower in Group B (1.65 ± 0.61) compared to Group A (2.29 ± 0.86) (p = 0.00). Conclusion: Both subcutaneous infiltration and intraperitoneal instillation of bupivacaine effectively reduce early postoperative pain following laparoscopic cholecystectomy. However, intraperitoneal instillation provides significantly superior pain control at both early and later postoperative periods.

Assessment of Preparedness Regarding Disaster Management Among Nurses

2025-04-07T11:27:21+00:00

Nurses are pivotal in disaster preparedness and response, especially in tertiary care settings where timely and effective intervention is critical. Evaluating their readiness is essential to developing targeted strategies for emergency preparedness. Objective: To assess the preparedness of tertiary care nurses regarding disaster management. Methods: A cross-sectional study was conducted at the Nursing Department of Medicare Hospital, Multan, from February 2024 to February 2025. A total of 100 registered nurses employed permanently at the hospital were enrolled. Data were collected using a structured questionnaire based on a modified version of the Disaster Preparedness Evaluation Tool, comprising 46 items rated on a six-point Likert scale (1 = strongly disagree to 6 = strongly agree). The tool assessed three core dimensions: knowledge, mitigation, response, and evaluation. Statistical analysis was performed using SPSS version 25, and p ≤ 0.05 was considered significant. Results: The study found that prior training did not significantly improve disaster preparedness knowledge (p = 0.783) or evaluation (p = 0.293). However, training was significantly associated with enhanced emergency response skills (p = 0.027). The inter-dimension correlation coefficient was high (r = 0.92), indicating internal consistency. The mean score for the 25 items related to general knowledge, management skills, and family preparedness was 3.08. The score for 15 items on patient-related knowledge and skills was 2.49, while the score for the six items related to evaluation was 2.50. Conclusion: The study revealed inadequate disaster preparedness among tertiary care nurses, despite the region’s vulnerability to natural disasters. Continuous education and hands-on training programs are necessary to enhance their readiness and response capabilities.

Frequency of Prediabetes in Patients With High BMI Presenting to a Tertiary Care Hospital

2025-04-14T17:00:59+00:00

Prediabetes is characterized by elevated blood sugar levels but not yet diabetes. Preventive interventions are crucial to prevent the progression to full-blown diabetes. Objective: This study aimed to determine the Frequency of prediabetes in patients with high BMI presenting to a tertiary care hospital. Method: The current cross-sectional study was conducted at the Department of Medicine, Qazi Hussain Medical Complex, Nowshera, over 6 months (July to December 2024) after taking permission from the ethical board of the institute. A total of 126 individuals with high BMI (body mass index 25 ≥ kg/m2) of both genders and different age groups (18-85 years) were included. Demographic data, including BMI, gender, age, education, employment, residence, and socioeconomic position, were collected. A history of hypertension and smoking was also reported. Participants with a high BMI were tested for pre-diabetes using Fasting Plasma Glucose (FPG) or Hemoglobin A1c (HbA1c) evaluations. Data was analyzed through SPSS version 25. The post-stratification chi-square or Fisher's exact test was applied to determine the significance. Results: A total of 126 individuals were screened in this study, out of which 20(15.8%) were found to be pre diabetes. Of the prediabetes individuals, 13 (65%) were males and 7(45%) were females. In this study, 75% of individuals had a family history of diabetes, one of the prediabetes risk factors. Most research participants (50%) come from lower-income families and live in rural regions (75%). A history of hypertension was observed in 85% of the individuals, and smoking in 70% of the participants. The majority (90%) were overweight, while 10% were obese. The Chi-Square test results showed values of 0.03, showing a strong association between prediabetes and body mass index (p-value <0.05). Conclusion: The present study concluded that the Frequency of prediabetes was 15.8% in patients with high BMI 15.8%. A significant association exists between prediabetes and BMI (Chi square = 0.31, p-value < 0.05).

Open-Label Randomized Controlled Trial to Assess the Efficacy and Safety of Triple Therapy With Aspirin, Clopidogrel, and Rivaroxaban Versus Dual Therapy With Aspirin and Clopidogrel in Patients With Acute Coronary Syndrome

2025-04-05T07:28:59+00:00

Acute coronary syndrome (ACS) is a significant contributor to cardiovascular morbidity and mortality. This study aimed to evaluate the efficacy and safety of triple therapy with aspirin, clopidogrel, and rivaroxaban compared to dual therapy with aspirin and clopidogrel in patients with ACS. Methods: This open-label, randomized controlled trial was conducted at the Punjab Institute of Cardiology from May 2024 to October 2024. Ninety patients with ACS were randomized into two groups: the triple therapy group (n=45) receiving aspirin (75–100 mg daily), clopidogrel (75 mg daily), and rivaroxaban (2.5 mg twice daily), and the dual therapy group (n=45) receiving aspirin (75–100 mg daily) and clopidogrel (75 mg daily). The primary efficacy outcome was the incidence of major adverse cardiac events (MACE), including recurrent myocardial infarction, ischemic stroke, and cardiovascular death, assessed over three months. The primary safety outcome was the incidence of bleeding events, categorized according to the Bleeding Academic Research Consortium (BARC) classification. Secondary outcomes included medication adherence and quality of life, as measured by the EQ-5D. Results: At three months, the incidence of major adverse cardiovascular events (MACE) was lower in the triple therapy group (6.7%) compared to the dual therapy group (15.6%). However, the difference was not statistically significant (p = 0.18). Minor bleeding was more common in the triple therapy group (13.3% vs. 4.4%, p = 0.14), while significant bleeding was rare (2.2% vs. 0%, p = 0.31). Quality of life scores were comparable between groups (76.2 ± 6.8 vs. 74.5 ± 7.2, p = 0.28). Adherence rates were high in both groups (93.3% vs. 95.6%, p = 0.71). Conclusion: Triple therapy demonstrated a trend towards reduced MACE compared to dual therapy but was associated with an increased risk of minor bleeding. These findings highlight the need for individualized therapy in patients with ACS, particularly in the Pakistani population. Further large-scale studies are recommended to validate these results.

Frequency of Genitourinary Abnormalities in Patients Having Anorectal Anomalies

2025-04-14T09:33:42+00:00

Anorectal malformations (ARMs) are frequently associated with genitourinary anomalies, which can lead to significant morbidity if left undiagnosed. Early detection is critical for optimal clinical management and prognosis. Objective: To determine the frequency and pattern of genitourinary abnormalities in neonates diagnosed with anorectal malformations. Methods: A descriptive cross-sectional study was conducted at the Department of Pediatric Surgery, Lady Reading Hospital, Peshawar, Pakistan, from 05-07-2024 to 05-01-2025. One hundred fifty-one neonates aged 1–30 days with radiologically confirmed ARMs were enrolled through non-probability consecutive sampling. Neonates with prior surgical interventions or genital ambiguity were excluded. Data on demographic variables and ARM type (high vs. low lesion) were collected. Genitourinary anomalies were identified through clinical examination, ultrasound, voiding cystourethrogram (VCUG), and intravenous pyelography. Statistical analysis was performed using SPSS version 25, and p-values <0.05 were considered significant. Results: Out of 151 neonates, 89 (58.9%) were male and 62 (41.1%) were female. Genitourinary anomalies were present in a substantial proportion of patients. The most common abnormality was vesicoureteral reflux (VUR), found in 52 cases (34.4%), followed by hypospadias in 19 cases (12.6%), ureteropelvic junction obstruction (UPJO) in 18 cases (11.9%), and undescended testis (UDT) in 8 cases (5.3%). Hypospadias and UDT were exclusively observed in male neonates (p < 0.001). High-type ARMs (n=63, 41.7%) were significantly associated with increased genitourinary anomaly frequency. Conclusion: Genitourinary anomalies, particularly vesicoureteral reflux, are common in neonates with anorectal malformations, especially those with high-type lesions. Routine screening with ultrasound and VCUG is essential to identify and manage these associated abnormalities early, thereby improving long-term outcomes.

Spectrum of Neurological Disorders Undergoing Plasmapheresis in a Tertiary Care Hospital

2025-03-22T10:25:25+00:00

Plasmapheresis is a therapeutic modality widely used in various immune-mediated neurological disorders. Understanding the clinical characteristics, disease spectrum, and treatment outcomes in patients undergoing plasmapheresis can help optimize its use in neurology. Objective: To analyze the demographic characteristics, clinical profile, comorbid conditions, laboratory parameters, and outcomes of patients with neurological disorders treated with plasmapheresis at a tertiary care hospital. Methods: A cross-sectional study was conducted in Ward 28, Department of Neurology, Jinnah Postgraduate Medical Centre (JPMC), Karachi, from November 15, 2024, to February 15, 2025, after obtaining ethical approval. A total of 145 patients aged 15–70 years, of either gender, presenting with suspected neurological diseases and undergoing plasmapheresis, were enrolled using non-probability consecutive sampling. Clinical presentations, diagnoses, and outcomes were recorded and analyzed. Results: The mean age of patients was 40.1 ± 15.6 years, with an average height of 1.7 ± 0.14 meters and weight of 74.11 ± 14.1 kg. Weakness and pain were the most common presenting symptoms, each reported in 72 patients (49.65%). The most frequently diagnosed condition was Guillain-Barré Syndrome (GBS) in 77 patients (53.10%), followed by Myasthenia Gravis (MG) in 36 (24.83%), Neuromyelitis Optica Spectrum Disorder (NMOSD) in 22 (15.17%), and Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD) in 10 patients (6.90%). Conclusion: The findings highlight Guillain-Barré Syndrome as the most common neurological condition requiring plasmapheresis. Variations in demographic and clinical features emphasize the need for localized data to inform diagnostic accuracy and therapeutic strategies in immune-mediated neurological disorders.

Functional outcomes of extra-articular distal radius fracture using T-butter plate

2025-04-12T13:28:05+00:00

Extra-articular distal radius fractures are common upper limb injuries, and optimal surgical intervention remains debated. While Kirschner’s wire (K-wire) fixation is traditionally used, volar locking plates such as the T-butterfly (T-butters) plate offer potentially superior outcomes. Objective: To assess the functional outcome of extra-articular distal radius fractures treated with T-butters volar locking plate compared to closed reduction and K-wire fixation. Methods: This quasi-experimental study was conducted at SKBZ/CMH Muzaffarabad after obtaining ethical approval from January to July 2023. A total of 70 patients aged 20–40 years with extra-articular distal radius fractures were randomized into two equal groups: Group T (open reduction and internal fixation with T-butters volar locking plate) and Group K (closed reduction and K-wire fixation followed by plaster immobilization). Functional outcomes were evaluated at 20 weeks postoperatively using a standardized scoring system. Results: In Group T, 12 patients (34.3%) had excellent outcomes, 20 (57.1%) had good outcomes, and 3 (8.6%) had fair outcomes, with no poor outcomes reported. In Group K, two patients (5.7%) had excellent outcomes, 18 (51.4%) had good outcomes, 12 (34.3%) had fair outcomes, and three patients (8.6%) had poor outcomes. Functional outcomes were significantly better in Group T compared to Group K (p < 0.05). Conclusion: The use of T-butters volar locking plate for the fixation of extra-articular distal radius fractures provides superior functional outcomes with fewer complications compared to K-wire fixation. It should be considered a preferred method of surgical management for such fractures in young adults.

Diagnostic Accuracy of MRCP in the Evaluation of Obstructive Jaundice

2025-03-21T16:04:18+00:00

Obstructive jaundice is a significant clinical condition that requires timely and accurate diagnosis to guide appropriate management. Endoscopic Retrograde Cholangiopancreatography (ERCP) is considered the gold standard but is invasive and associated with potential complications. Magnetic Resonance Cholangiopancreatography (MRCP) offers a non-invasive alternative, and its diagnostic accuracy warrants evaluation. Objective: To determine the diagnostic accuracy of MRCP in diagnosing obstructive jaundice using ERCP as the reference standard. Methods: This prospective observational study was conducted at the Jinnah Postgraduate Medical Centre (JPMC), Karachi, from September 1, 2024, to February 28, 2025, after obtaining ethical approval. A total of 109 patients aged 18 years or older, of either gender, presenting with clinical features of obstructive jaundice, including jaundice, pruritus, dark-colored urine, and pale stools, were enrolled through non-probability sampling. Patients with contraindications to MRCP or a history of prior biliary surgery were excluded. MRCP findings were compared with ERCP to evaluate diagnostic accuracy. Receiver Operating Characteristic (ROC) curve analysis was performed using SPSS Version 25. Results: MRCP demonstrated a sensitivity of 86.4% and specificity of 88% in diagnosing obstructive jaundice when compared with ERCP. ROC curve analysis revealed an area under the curve (AUC) of 0.864, with a statistically significant p-value (<0.001), indicating strong diagnostic performance. Conclusion: MRCP demonstrates high diagnostic accuracy in detecting obstructive jaundice and can serve as a reliable, non-invasive alternative to ERCP, particularly in the initial diagnostic evaluation or in patients where ERCP is contraindicated.

Mean Change in Respiratory Functions With Paracentesis in Chronic Hepatitis C Patients With Cirrhotic Ascites

2025-04-10T11:57:51+00:00

Chronic Hepatitis C (CHC) with cirrhotic ascites is associated with significant respiratory dysfunction due to mechanical compression of the diaphragm and lungs. Objective: To evaluate the mean change in respiratory functions following paracentesis in patients with chronic Hepatitis C and cirrhotic ascites. Methods: A cross-sectional study was conducted at the Department of Internal Medicine, Akhtar Saeed Trust Hospital, Lahore. A total of 154 patients aged 25-65 years with chronic Hepatitis C and cirrhotic ascites were enrolled. Patients underwent baseline assessments of respiratory function, including circumferential measurements and ventilometry, 30 minutes before and after paracentesis. Results: Significant improvements in respiratory function were observed following paracentesis. Tidal volume increased by 90 ± 50 mL (p < 0.001), minute volume by 0.8 ± 0.4 L/min (p < 0.001), and vital capacity by 0.6 ± 0.3 L (p < 0.001). Respiratory rate decreased by 2 ± 1 breaths/min (p < 0.001). Circumferential measurements at axillary, xiphoid, and umbilical reference points showed significant reductions, indicating decreased abdominal pressure. These improvements were consistent across gender and age groups. Conclusion: Paracentesis significantly improves respiratory function in patients with chronic Hepatitis C and cirrhotic ascites. The procedure reduces intra-abdominal pressure, enhances lung expansion, and improves ventilatory parameters. Paracentesis should be considered a valuable therapeutic intervention for both ascites and respiratory dysfunction in this patient population.

Diagnostic Accuracy of Prolactin Levels in Pituitary Microadenoma Keeping MRI as A Gold Standard

2025-04-09T17:15:01+00:00

Pituitary microadenomas are small, benign pituitary gland tumors often associated with elevated serum prolactin levels. Early detection is crucial for prompt management, but imaging with MRI remains the gold standard. Evaluating the diagnostic utility of serum prolactin levels can help streamline the diagnostic pathway, especially in resource-limited settings. Objective: The present study aims to assess the diagnostic accuracy of prolactin levels in diagnosing pituitary microadenomas, keeping MRI as the Gold Standard. Methods: After the ethical approval from the institutional review board, this cross-sectional study was conducted at the Department of Radiology, Jinnah Postgraduate Medical Centre, Karachi, from 03/December/2024 to 03/February/2025. Through non-probability consecutive sampling, 98 patients, aged 18–65 years, of either gender, with clinical suspicion of pituitary microadenomas and having serum prolactin levels ≥25 ng/mL, were included in the present study. Results: The sensitivity of serum prolactin in detecting pituitary microadenomas was 89.06%, indicating its ability to identify affected individuals correctly. However, the specificity was lower at 41.18%, suggesting a higher likelihood of false positives. The ROC curve analysis with an AUC of 0.866 for Prolactin level in predicting microadenomas, taking MRI as the gold standard. Conclusion: First-line diagnostic screening employing serum prolactin testing shows promising results in detecting pituitary microadenomas because of high sensitivity, yet requires an additional MRI examination to confirm the conclusive diagnosis of the condition.

Diagnostic Accuracy of MRI Myelogram in Cases of Spinal Stenosis, Keeping Neurosurgical Findings as a Gold Standard

2025-04-09T16:54:14+00:00

Lumbar spinal stenosis (LSS) is a prevalent condition associated with neurogenic claudication and radiculopathy, often requiring surgical intervention for definitive management. While conventional MRI is commonly used, MRI myelography offers a non-invasive, contrast-free alternative that may improve diagnostic accuracy. However, its reliability against intraoperative neurosurgical findings, the gold standard, requires validation. Objective: The present study aims to evaluate the diagnostic accuracy of MRI myelogram in detecting spinal stenosis, keeping neurosurgical findings as the gold standard, in patients presenting to a tertiary care hospital in Pakistan. Methods: After the ethical approval from the institutional review board, this cross-sectional study was conducted at the Department of Radiology & Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi from 03/December/2024 to 03/February/2025. Through non-probability consecutive sampling, 123 patients aged 18 years or older, of either gender, presenting with symptoms of spinal stenosis (e.g., neurogenic claudication, radiculopathy, or myelopathy), undergoing MRI myelogram followed by neurosurgical evaluation or intervention, were included in the present study. Results: The sensitivity of MRI myelography for diagnosing spinal stenosis was found to be 91.80%, indicating its strong ability to detect actual positive cases. The specificity was calculated at 87.27%, reflecting its reliability in correctly identifying negative cases. The ROC curve analysis with an AUC of 0.89 of MRI myelography findings in predicting LSS, taking intraoperative neurosurgical findings as the gold standard. Conclusion: MRI myelography is an extremely sensitive imaging technique requiring minimal intervention to diagnose lumbar spinal stenosis.

To Study the Health-Related Quality of Life (HRQOL) in Children Presenting with Guillain-Barré Syndrome (GBS) in a Tertiary Care Hospital

2025-04-09T12:36:35+00:00

Guillain-Barré Syndrome (GBS) is a rare and potentially life-threatening neurological disorder caused by an aberrant autoimmune response, leading to acute inflammation and damage to the peripheral nerves. Objective: The purpose of this study is to provide a comprehensive description of the impact of GBS on children, including functional disability and health-related quality of life, using the Hughes score. Methodology: This Cross-sectional observational study was conducted in the inpatient and outpatient departments of the Pakistan Institute of Medical Sciences Children's Hospital, Islamabad. Seventy-four children aged 1- 12 with GBS were recruited and followed for 1 year. Clinical characteristics of the disease, functional disability score, and HRQOL were reported at 3 and 6 months. Results: The Study showed a male predominance (78.4%) and the majority aged < 5 years (47.3%). Seasonal variation revealed the highest incidence during winter (62.2%), followed by summer (18.9%). Preceding symptoms included upper respiratory tract infections (35.1%) and diarrhea (18.9%); the rest of the children had no preceding risk factors. The clinical presentation of Guillain-Barré Syndrome (GBS) in the study cohort was dominated by limb weakness (100%) and areflexia (100%), with muscle pain also being prevalent (83.8%). Complications included cranial nerve palsies (41.9%) and autonomic instability (55.4%). At discharge, 50% required walking assistance, and 44.6% were bedridden or chair-bound. Over six months, significant functional improvements were observed, with 86.1% having normal function and only 8.3% still needing walking assistance. Health-related quality of life assessments showed marked physical, emotional, and social enhancements over three and six months. However, two patients (2.7%) experienced rapid disease progression leading to death, underscoring the severity of GBS despite overall positive outcomes. Conclusion: It is concluded that Guillain-Barré Syndrome (GBS) significantly impacts the health-related quality of life (HRQOL) in children, affecting their physical, emotional, and social well-being.

Socio-Demographic Determinants of Medication Compliance in Bipolar Disorder Patients in Lahore, Pakistan

2025-04-18T20:42:29+00:00

Medication non-compliance is a major challenge in the long-term management of bipolar disorder, contributing to relapse, hospitalization, and poor quality of life. Socio-demographic factors can significantly influence adherence behavior, yet data specific to the Pakistani population remain limited. Objectives: The study's primary objective was to evaluate medication compliance in bipolar patients and identify the associated socio-demographic variables affecting medication compliance. Methodology: An analytical cross-sectional study was conducted at the teaching hospital in Lahore, Punjab, which specializes in mental health. A questionnaire based on the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) was utilized, with a sample size of 296 patients aged 18 and above. Statistical analysis was performed using R Studio software. Results: The analysis revealed a median SEAMS score of 19 (IQR = 18, 22). Males demonstrated slightly higher adherence than females (median SEAMS score of 20 vs. 19, respectively). Unmarried individuals exhibited better adherence (median = 21) than married participants (median = 19). Students reported the highest compliance (median = 22), while unemployed individuals had the lowest (median = 18). Significant differences in SEAMS scores were observed across employment and education levels. The robust gamma regression analysis confirmed that uneducated participants (exp(β) = 0.836, p < 0.001) and unemployed individuals (exp(β) = 0.980, p = 0.219) exhibited lower adherence. Additionally, those aged 30-44 and 45-59 showed significantly higher adherence (exp(β) = 1.048, p = 0.014 and exp(β) = 1.050, p = 0.026, respectively). Conclusion: The study highlights the significant influence of sociodemographic factors, particularly employment status and education level, on medication compliance. While gender and age also contribute, the findings suggest that targeted interventions aimed at addressing disparities in employment and education could improve medication adherence in patients with bipolar disorder.

Knowledge and Attitude of Nursing Staff Regarding Preventability of Pressure Ulcers

2025-04-07T16:33:43+00:00

Pressure ulcers are a significant health concern in hospitalized patients and a key indicator of nursing care quality. Adequate knowledge and positive attitudes among nurses are essential for effectively preventing and managing pressure ulcers. Objective: To assess the level of knowledge and attitudes of nurses working at Medicare Hospital, Multan, regarding pressure ulcers. Methods: An exploratory cross-sectional study was conducted at Medicare Hospital, Multan, from February 2024 to February 2025. A total of 100 nurses from various departments were recruited based on availability. Knowledge was assessed using the 26-item Pressure Ulcer Knowledge Assessment Tool, which covered six key dimensions of pressure ulcer prevention and management. Attitudes were evaluated using a 13-item Attitudes Towards Pressure Ulcers Prevention (APuP) tool. Data were analyzed using SPSS version 25. Results: The overall mean knowledge score was 50.4% (12.01 ± 3.91), with only 10% of nurses achieving a high knowledge level (≥60%). The highest knowledge scores were recorded in the nutrition domain (80%), while the lowest were in risk assessment (40%). The mean attitude score was 68.2% (35.45 ± 12.00), below the satisfactory threshold of 75%. Only 55% of participants demonstrated a satisfactory attitude toward pressure ulcer prevention. Conclusion: Nurses at Medicare Hospital exhibited unsatisfactory levels of knowledge and suboptimal attitudes regarding pressure ulcer prevention. These findings highlight the urgent need for structured educational interventions and training programs to improve patient care outcomes related to pressure ulcers.

Assessment of Professional Values Among Nurses Working in Tertiary Care Hospitals: A Descriptive Cross-Sectional

2025-04-16T11:21:55+00:00

Professional values form the ethical foundation of nursing practice and are essential for ensuring quality, equitable, and patient-centered care. Despite their importance, individual and organizational factors can influence the consistent application of these values in clinical settings. Objective: This study aims to assess the prevalence, perception, and application of professional values among nurses working in tertiary care hospitals in Lahore, Pakistan. Methods: A descriptive cross-sectional study was conducted among 120 registered nurses using a structured, validated 26-item questionnaire. The Punjab Institute of Cardiology and the Mayo Hospital recruited participants through convenience sampling. Descriptive statistics summarized demographic data and item responses. Internal consistency was evaluated using Cronbach’s alpha, and construct validity was tested through the KMO measure and Bartlett’s Test of Sphericity. Results: Most female respondents (99.2%) worked primarily in emergency or general wards. Nurses agreed with integrity, patient privacy, and professional responsibility values. The lowest scores were associated with ethically sensitive decisions such as refusal of care based on personal values. The scale demonstrated high internal reliability (Cronbach’s alpha = 0.920) and strong construct validity (KMO = 0.858, Bartlett’s p < 0.001). Education level and clinical experience were positively associated with higher value adherence. Conclusion: While nurses generally recognize professional values, practical challenges hinder their consistent application. Strengthening ethical training, institutional support, and mentorship programs is essential to reinforcing value-based practice across all clinical settings.

Assessment of Nurses' Knowledge and Practices Regarding Infection Control Measures in Tertiary Care Hospitals of Pakistan

2025-04-07T05:44:56+00:00

Infection control is a cornerstone of patient safety in healthcare settings. Nurses play a vital role in implementing infection prevention protocols, yet disparities often exist between their knowledge and actual practices. In Pakistan, healthcare-associated infections (HAIs) remain a significant concern due to suboptimal compliance with standard precautions. Objective: This study aimed to assess the knowledge and practices of registered nurses regarding infection control measures in a tertiary care hospital in Lahore, Pakistan. Methods: A descriptive cross-sectional study was conducted at tertiary care hospitals from April to September 2024. A total of 58 registered nurses were selected through purposive sampling. Data were collected using a structured, pre-validated questionnaire comprising demographic details, knowledge-based questions, and practice-related items aligned with WHO and CDC infection control guidelines. Data were analysed using SPSS version 26, with descriptive statistics and Pearson's correlation to assess the relationship between knowledge and practice. A p-value <0.05 was considered statistically significant. Results: Among the 58 nurses, 31% demonstrated good knowledge, 44.8% had moderate knowledge, and 24.2% had poor knowledge of infection control. Practice assessment showed that 34.5% exhibited good practices, 46.6% moderate, and 18.9% poor practices. A statistically significant positive correlation (r = 0.64, p < 0.001) was found between knowledge and practice scores. Nurses with higher qualifications and more clinical experience performed better in both domains. Conclusion: The study highlights moderate infection control knowledge and practice levels among nurses, with apparent gaps requiring attention. Strengthening infection control training and regular competency evaluations are essential for improving adherence and reducing the burden of HAIs in Pakistani healthcare settings.

Efficacy of Ilizarov Technique in the Treatment of Infected Nonunion of the Tibia

2025-04-14T11:20:45+00:00

Infected non-union of the tibia remains a significant clinical challenge due to the bone’s subcutaneous location and high risk of complications such as delayed healing and infection. The Ilizarov external fixator is increasingly recognized as an effective method for managing such cases, offering biomechanical stability and facilitating bone regeneration. Objective: To evaluate the outcomes of Ilizarov external fixation in treating infected tibial non-unions, focusing on bone healing, functional results, and complications. Methods: A retrospective study was conducted at the Department of Orthopaedic Surgery, Shaikh Zayed Hospital, Lahore, from January 2022 to December 2023. A total of 52 patients with infected tibial non-union were included. Patient records were reviewed for microbiological findings, duration of treatment, union rates, bone and functional outcomes using the ASAMI (Association for the Study and Application of the Method of Ilizarov) grading system, and complication rates. Results: Staphylococcus aureus was the most commonly isolated organism. At final follow-up, union was achieved in 50 out of 52 patients (96.2%). One patient required amputation due to persistent non-union and sepsis. Based on ASAMI bone results, 23 patients (44.2%) had excellent outcomes, 20 (38.5%) had good outcomes, 6 (11.5%) had fair outcomes, and 3 (5.8%) had poor outcomes. Functional outcomes were satisfactory in the majority of patients. Conclusion: The Ilizarov technique is highly effective for managing infected tibial non-unions. It enables bone union, deformity correction, infection control, and early weight-bearing. Its use should be strongly considered in treating complex tibial non-unions secondary to infection.

Comparison of Supratarsal Injection of Triamcinolone Acetonide and Topical Tacrolimus in the Treatment of Refractory Vernal Keratoconjunctivitis

2025-04-05T05:44:16+00:00

Vernal keratoconjunctivitis (VKC) is a chronic allergic ocular condition commonly affecting young individuals in tropical and subtropical regions. This study aimed to compare the efficacy of supratarsal injection of triamcinolone acetonide and topical tacrolimus 0.03% in patients with refractory VKC. Methods: A randomised controlled trial was conducted at the Department of Ophthalmology, Nishtar Hospital Multan, from August 2 to February 2, 2025. Seventy patients with clinically diagnosed refractory VKC were randomised into two groups: Group A received a single supratarsal injection of triamcinolone acetonide (20 mg/mL). In contrast, Group B received 0.03% topical tacrolimus twice daily for three weeks. The primary outcome was clinical improvement of symptoms and signs (lid edema, chemosis, congestion, watering, and papillae size) assessed at three weeks. Statistical analysis was performed using SPSS v. 25. Results: Group A showed significantly higher rates of clinical improvement (85.7%) compared to Group B (60%) (p = 0.006). Resolution of lid edema (88.6% vs 68.6%, p = 0.032), chemosis (85.7% vs 62.9%, p = 0.018), and congestion (91.4% vs 65.7%, p = 0.007) was more pronounced in the triamcinolone group. Stratified analysis revealed better outcomes in male and rural patients across both groups, but triamcinolone consistently demonstrated superior efficacy. Conclusion: Supratarsal triamcinolone injection is more effective than topical tacrolimus 0.03% in managing refractory VKC in the Pakistani population. Its rapid action and ease of administration support its use as a first-line option in cases of severe or unresponsive conditions.

Cardiac CT Assessment of Left Atrial Appendages Anatomy in Patients Undergoing Coronary CT Angiography

2025-04-14T07:57:11+00:00

The left atrial appendage (LAA) is an anatomical, finger-like projection that arises from the left atrium (LA), characterized by unique anatomical and physiological properties distinct from those of the main atrial body. Embryologically, the LAA represents a remnant of the primordial left atrium. The morphological diversity of the left atrial appendage (LAA) is clinically significant, influencing the risk of thromboembolic events and the management strategies in patients with cardiac disease. This study aimed to evaluate the frequency distribution of four distinct morphological types of the LAA among patients undergoing cardiac imaging. Objective: To determine the frequency of four morphological types (chicken wing, windsock, cauliflower, and cactus) of the left atrial appendage using cardiac computed tomography (CT). Methods: A cross-sectional descriptive study was conducted at the Cardiac Imaging Section, Medical Teaching Institute - Hayatabad Medical Complex, Peshawar, Pakistan, from July 22, 2022, to January 22, 2023. All included patients underwent imaging using a minimum 64-slice cardiac CT scanner, without preference for a specific vendor. Patients presented in a non-fasting state to ensure consistent loading conditions of the left atrium, as fasting state variations could affect the assessment of LAA morphology. Results: Out of 167 patients, the chicken wing morphology was the most prevalent, identified in 57 patients (34.1%). The cactus morphology was observed in 40 patients (24.0%), followed by the windsock morphology in 39 patients (23.4%), and the cauliflower morphology in 31 patients (18.6%). Conclusion: This study highlights chicken wing morphology as the predominant type among patients attending cardiac imaging at our institution, followed by cactus, windsock, and cauliflower types. Awareness of the prevalence and distribution of LAA morphologies within specific populations can aid in clinical decision-making, particularly in assessing stroke risk and developing personalized therapeutic approaches.

Diagnostic Accuracy of Contrast-Enhanced MRI in Diagnosing and Staging Urinary Bladder Carcinoma, Taking Histopathology as Gold Standard

2025-03-22T10:00:21+00:00

Urinary bladder carcinoma is a common malignancy with significant morbidity and mortality. Accurate diagnosis and staging are essential for guiding treatment decisions. Contrast-enhanced magnetic resonance imaging (CE-MRI) provides a non-invasive approach for evaluating bladder tumours; however, its diagnostic accuracy compared to histopathology, the gold standard, requires validation. Objective: To evaluate the sensitivity, specificity, and diagnostic accuracy of contrast-enhanced MRI in diagnosing and staging urinary bladder carcinoma in comparison to histopathological findings. Methods: This prospective observational study was conducted at the Jinnah Postgraduate Medical Centre (JPMC), Karachi, from September 1, 2024, to February 28, 2025, following ethical approval. A total of 25 patients aged ≥18 years, of either gender, with clinical suspicion of urinary bladder carcinoma, were enrolled using non-probability consecutive sampling. Patients with contraindications to MRI or a history of contrast allergy were excluded. All patients underwent CE-MRI followed by cystoscopic biopsy for histopathological confirmation. The sensitivity, specificity, and diagnostic accuracy of CE-MRI were calculated by comparing MRI findings with histopathological results. Results: CE-MRI demonstrated a sensitivity of 53.85%, specificity of 75%, and an overall diagnostic accuracy of 64% in detecting and staging urinary bladder carcinoma. Conclusion: Contrast-enhanced MRI shows moderate diagnostic accuracy in the detection and staging of urinary bladder carcinoma. While it provides valuable non-invasive insights, its limited sensitivity underscores the continued importance of histopathology for definitive diagnosis.

Analysis of the Level of Knowledge of Nurses Regarding Nutritional Diet Regimes

2025-04-12T09:48:36+00:00

Nutritional counseling is a critical component of disease prevention and management. Nurses, being at the forefront of patient care, must possess adequate knowledge about dietary regimens to effectively guide patients with chronic diseases such as diabetes, cardiovascular disease (CVD), and obesity. However, data on nurses’ nutritional knowledge in hospitals remains limited in Pakistan. Objective: To analyze the knowledge of registered nurses regarding nutritional diet regimens for obesity, diabetes, and cardiovascular diseases (CVD) in a tertiary care hospital. Methods: A cross-sectional study was conducted in the Nursing Department of Nishtar Hospital, Multan, from February 2024 to February 2025. One hundred registered nurses working the day shift across various departments (internal medicine, neurology, surgery, obstetrics, pediatrics, and nephrology) were surveyed. Basic demographic data were recorded, including qualification, years of experience, and department. A validated 42-item questionnaire assessed knowledge of dietary management for diabetes, obesity, and CVD. Data were analyzed using SPSS version 25. Statistical significance was determined using appropriate inferential tests with a p-value ≤ 0.05. Results: The overall nutritional knowledge level among nurses was 59%, with subcategory scores of 69% for diabetes, 54% for obesity, and 59% for CVD. Knowledge scores were significantly higher among nurses with 11 or more years of experience (p = 0.019) and those holding a master’s degree (p = 0.018). However, knowledge scores across different hospital departments found no statistically significant difference. Conclusion: Nurses demonstrated below-average knowledge regarding nutritional regimens for patients with diabetes, CVD, and obesity. This highlights the urgent need for structured education and training programs focused on clinical nutrition to effectively empower nurses to manage the growing burden of non-communicable diseases.

Hearing Improvement in Patients Undergoing Underlay Technique in Myringoplasty

2025-04-09T17:35:34+00:00

Chronic tympanic membrane perforations can result in significant conductive hearing loss. Myringoplasty, particularly the underlay technique, is a commonly performed surgical procedure to restore membrane integrity and improve hearing outcomes. Evaluating the effectiveness of this technique is vital for evidence-based clinical decision-making. Objective: The present aim is to determine the frequency of Hearing improvement in patients undergoing the underlay technique in myringoplasty. Methods: After the ethical approval from the institutional review board, this Descriptive case series study was conducted at the Department of ENT, Shalimar Hospital, Lahore, from August 01, 2024, to February 01, 2025. Through non-probability consecutive sampling, 150 patients aged 18-60, both genders, with Central tympanic membrane perforations were included in the present study. Results: In terms of hearing loss and air-bone gap (ABG) before and after surgery, significant improvements were observed, as detailed in Table 2. Pre-operatively, the average hearing loss was 55.9 ± 13.8 dB, which improved to 41.2 ± 14.1 dB post-operatively (p < 0.0001). Similarly, the average pre-operative air-bone gap was 20.01 ± 6.03 dB, which decreased to 14.5 ± 6.4 dB after surgery, indicating a significant reduction in the gap (p < 0.0001). One hundred twenty-one patients (80.7%) experienced hearing improvement, while 29 (19.3%) did not. Conclusion: The underlay approach in myringoplasty surgery brings substantial auditory benefits by reducing both disability degrees and air-bone gaps after surgery is complete.

Efficacy and Safety of Suprachoroidal Triamcinolone Acetonide in Cases of Resistant Diabetic Macular Edema

2025-04-09T17:08:54+00:00

Diabetic macular edema (DME) in people with diabetes often resists standard treatments. Suprachoroidal triamcinolone acetonide injections target therapy, potentially improving outcomes with fewer side effects. This study aims to advance understanding of its efficacy and safety in managing DME, adding to the limited literature. Objective: To evaluate the safety and effectiveness of SCTA injection in patients with resistant diabetic macular edema. Methods: The study was conducted at the Department of Ophthalmology, Sir Ganga Ram Hospital, Lahore. The study duration was 6 months from 5th June 2024 to Dec 5th 2024. After approval, 30 patients with resistant DME and meeting the inclusion criteria were enrolled in the study after taking informed written consent. A special technique was used to administer suprachoroidal triamcinolone acetonide. Patient follow-up was done at 1 month and 3 months after treatment to measure change in study variables from the baseline. Results: The study involved 30 participants. Mean logMAR BCVA decreased significantly at 1 month (0.56±0.053) and 3 months (0.42±0.072) from baseline (0.83±0.048), p=0.000. Mean CMT at 1 and 3 months was significantly lower than baseline, p=0.000, with a significant decrease between these periods. Mean IOP was significantly higher at 1 month (13.80±1.65 mmHg, p=0.000) compared to baseline (12.43±1.63 mmHg), and was insignificantly higher at 3 months (12.6±1.63 mmHg, p=0.056). Conclusion: Our study highlights suprachoroidal triamcinolone acetonide's efficacy in treating refractory diabetic macular edema, showing significant visual acuity improvement and central macular thickness reduction. Transient intraocular pressure increases were observed but reverted to baseline, affirming treatment safety and effectiveness.

To Compare the Kidney Dimensions in Healthy Individuals with Acute and Chronic Pyelonephritis Patients Using CT Scan as an Imaging Modality

2025-04-09T16:28:34+00:00

Acute or chronic pyelonephritis is a common renal pathology that can lead to significant kidney morphological changes. Accurate assessment of renal dimensions using imaging modalities such as computed tomography (CT) is essential for diagnosis and management. However, limited data on normal kidney dimensions and their variation in pyelonephritis in the adult Pakistani population are available. Objective: To compare normal kidney dimensions in healthy individuals with those in patients diagnosed with acute and chronic pyelonephritis on CT scan in the adult Pakistani population, and to correlate kidney size with age and gender. Methods: This case-control study was conducted at the Radiology Department of Jinnah Postgraduate Medical Centre, Karachi, over six months from September 2023 to February 2024. A total of 126 adults were included using a consecutive non-probability sampling technique: 77 healthy individuals (controls) and 49 patients diagnosed with acute or chronic pyelonephritis based on CT findings. Renal dimensions were measured using axial, coronal, and sagittal slices from multislice CT scans. Kidney lengths and transverse diameters were recorded. Statistical analysis was performed using the independent t-test to compare kidney dimensions between cases and controls and acute and chronic pyelonephritis groups. A p-value < 0.05 was considered statistically significant. Results: The mean age of patients with pyelonephritis was 45.8 ± 12.0 years. The mean transverse diameter of the right kidney in pyelonephritis cases was significantly larger (5.05 ± 0.18 cm) compared to controls (4.34 ± 0.06 cm) (p = 0.001). Among the pyelonephritis group, the mean transverse dimension of the left kidney in acute cases was 5.52 ± 1.00 cm, significantly larger than in chronic cases (4.44 ± 1.05 cm) (p = 0.001). Similarly, the right kidney in acute pyelonephritis had a mean transverse diameter of 5.52 ± 1.20 cm compared to 4.48 ± 0.65 cm in chronic pyelonephritis (p = 0.001). Conclusion: The study demonstrated that kidneys in patients with acute pyelonephritis are significantly swollen, whereas chronic infections are associated with renal atrophy. Additionally, the parenchymal thickness in pyelonephritis patients was significantly greater than in healthy controls. CT imaging is reliable for distinguishing between acute and chronic renal changes in pyelonephritis based on kidney dimensions.

Comparison of Pre-Oxygenation Using High-Flow Nasal Oxygen vs Tight Face Mask During Rapid Sequence Induction

2025-04-22T10:32:52+00:00

Pre-oxygenation prior to rapid sequence induction (RSI) is critical in minimizing the risk of hypoxemia during emergency surgeries. High-flow nasal oxygen (HFNO) has emerged as a promising alternative to conventional facemask pre-oxygenation; however, data from multicenter, real-time emergency settings remain limited. Objective: To compare the effectiveness of high-flow nasal oxygen versus tight-fitting facemask pre-oxygenation in preventing desaturation during RSI among adults undergoing emergency surgery. Methods: This randomized controlled trial was conducted at the Anesthesia Department of Gujranwala Teaching Hospital between September 2024 and February 2025. A total of 144 adult patients requiring emergency surgery and RSI were randomized equally into the HFNO group (n=77) and facemask group (n=77). All participants were pre-oxygenated with 100% oxygen. The primary outcome was the incidence of oxygen desaturation (SpO₂ <93%) from the start of pre-oxygenation to one minute after tracheal intubation. Secondary outcomes included rates of regurgitation and end-tidal carbon dioxide (EtCO₂) levels post-intubation. Statistical analysis was performed using the Chi-square test, and p ≤ 0.05 was considered significant. Results: Desaturation <93% occurred in 5 patients (2.9%) in the HFNO group and six patients (3.4%) in the facemask group (p = 0.77), indicating no significant difference. No increase in desaturation risk was noted during on-call hours. Regurgitation rates and EtCO₂ levels after intubation were comparable between groups. No adverse events related to either technique were reported. Conclusion: Both high-flow nasal oxygen and tight-fitting facemask pre-oxygenation are safe and effective in maintaining adequate oxygenation during RSI in emergency surgeries. HFNO offers comparable outcomes and may be considered a viable alternative, particularly in settings where facemask pre-oxygenation may be less practical.

Comparison of Mean Platelet Volume in Patients with and Without Diabetes Mellitus at a Tertiary Care Hospital

2025-04-08T15:33:50+00:00

Mean Platelet Volume (MPV) is a platelet activation marker linked to various cardiovascular diseases. Type 2 Diabetes Mellitus (T2DM) is known to increase the risk of thrombosis, and changes in platelet characteristics, including MPV, may contribute to this risk. Objective: This study aimed to compare the MPV in patients with and without T2DM at a tertiary care hospital. Methods: This randomized controlled trial was conducted at Akhtar Saeed Trust Hospital, Lahore, with 98 participants (49 diabetic and 49 non-diabetic) from 18 October 2024 Till 17 January 2025. Data were collected through non-probability consecutive sampling. MPV, fasting blood glucose (FBG), and HbA1c were measured for each patient. Results: The mean MPV was significantly higher in the diabetic group (9.94 ± 1.07 fL) compared to the non-diabetic group (9.36 ± 0.96 fL), with a p-value of 0.001. FBG and HbA1c levels were also significantly higher in the diabetic group. Stratified analysis showed consistent results across age and BMI categories, confirming that these factors did not confound the difference in MPV. Conclusion: It is concluded that T2DM is associated with higher MPV, suggesting increased platelet activation in diabetic patients. This may contribute to the elevated cardiovascular risk observed in this population. MPV could potentially serve as a biomarker for platelet dysfunction in diabetes, but further research is needed to explore its clinical significance and predictive value.