Biological and Clinical Sciences Research Journal

Accuracy of Combined Neutrophil to Lymphocyte Ratio and C-Reactive Protein for Diagnosis of Spontaneous Bacterial Peritonitis Among Cirrhotic Patients

2025-05-31T08:56:26+00:00

Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis associated with high morbidity and mortality. While ascitic fluid analysis remains the diagnostic gold standard, it is invasive and not always feasible. There is a need for simple, non-invasive, and cost-effective alternatives to diagnose SBP early, especially in resource-limited settings. Objective: To determine the diagnostic accuracy of combined neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels in diagnosing SBP among cirrhotic patients, using ascitic fluid PMN count as the gold standard. Methods: This descriptive cross-sectional study was conducted over six months from April 2024 to September 2024, at the Department of Medicine, Ibn-e-Siena Hospital, Multan. A total of 131 cirrhotic patients with ascites were included through non-probability consecutive sampling. All patients underwent diagnostic paracentesis. SBP was confirmed if PMN count in ascitic fluid was ≥250/mm³. NLR and CRP were assessed using venous blood samples. A cut-off of NLR ≥2.9 and CRP >11.3 mg/dL was used to define SBP positivity. Diagnostic indices were calculated using 2×2 contingency tables. Results: Out of 131 patients, 91 (69.5%) were confirmed to have SBP by ascitic fluid analysis. The combination of NLR and CRP showed a sensitivity of 94.5%, specificity of 85.0%, positive predictive value of 93.5%, negative predictive value of 87.2%, and overall diagnostic accuracy of 91.6%. Stratified analysis revealed consistent diagnostic performance across gender and duration of liver disease. Conclusion: Combined NLR and CRP are accurate, readily available, and non-invasive diagnostic markers for SBP in cirrhotic patients. Their application may complement or, in selected cases, substitute ascitic fluid analysis, improving early detection and outcomes in resource-limited settings such as Pakistan.

Comparison of Results of Standard Versus Accelerated Casting Method for Relapsed Club Foot Deformity

2025-05-30T08:42:17+00:00

Relapsed idiopathic clubfoot remains a significant clinical challenge in pediatric orthopedics, particularly in low-resource countries like Pakistan. While the standard Ponseti method with weekly casting is well-established, the accelerated casting method, requiring more frequent cast changes, offers potential advantages in reducing treatment time without compromising outcomes. Objective: To compare the effectiveness, complication rates, recurrence, and parental satisfaction between standard weekly casting and accelerated bi-weekly casting methods for relapsed clubfoot deformity in a tertiary care hospital in Pakistan. Methods: A prospective comparative study was conducted at the Department of Orthopedics, Benazir Bhutto Hospital, Rawalpindi, from September 15, 2024, to March 15, 2025. A total of 80 children with relapsed idiopathic clubfoot were divided into two equal groups: 40 treated with the standard Ponseti method and 40 with the accelerated method. Outcomes included a number of casts, treatment duration, Pirani score improvement, complication rates, recurrence at 6-month follow-up, and parental satisfaction using a 5-point Likert scale. Data were analyzed using SPSS v25.0, with independent t-tests and chi-square tests applied where appropriate. Results: Both groups achieved comparable deformity correction as reflected by similar final Pirani scores (0.7 ± 0.4 in standard vs. 0.6 ± 0.3 in accelerated, p = 0.312). The accelerated group required significantly fewer casts (5.1 ± 0.9 vs. 6.9 ± 1.1, p < 0.001) and shorter treatment duration (2.6 ± 0.5 weeks vs. 6.9 ± 1.1 weeks, p < 0.001). Complication and recurrence rates were low and statistically similar in both groups. Parental satisfaction was significantly higher in the accelerated group (mean score 4.4 ± 0.5 vs. 3.8 ± 0.7, p = 0.002). Conclusion: The accelerated Ponseti method is a safe and effective alternative to standard casting for relapsed clubfoot, offering faster correction and higher caregiver satisfaction without increasing complications or recurrence. Its adoption may enhance compliance and reduce treatment burden in the Pakistani healthcare setting.

Evaluating the Impact of Problem-Based Learning on Critical Thinking Skills in Undergraduate Nursing Students

2025-05-21T13:03:27+00:00

Critical thinking is an essential competency for nursing professionals, enabling them to make informed clinical decisions and ensure patient safety. In Pakistan, traditional lecture-based pedagogies dominate nursing education, often limiting the development of higher-order cognitive skills. Problem-based learning (PBL) has emerged as an effective student-centered strategy to enhance critical thinking, but its application in Pakistani nursing curricula remains limited. Objective: To evaluate the effectiveness of problem-based learning in improving critical thinking skills among undergraduate nursing students in a tertiary care teaching hospital in Pakistan. Methods: A quasi-experimental pre- and post-intervention study was conducted from April to September 2024 at the NMC Multan. A total of 86 undergraduate nursing students were recruited through non-probability convenience sampling. Participants underwent six weeks of structured PBL sessions integrated into their curriculum. Critical thinking skills were assessed before and after the intervention using a validated critical thinking disposition inventory. Data were analyzed using SPSS version 25, employing paired t-tests and ANOVA to determine statistical significance, with a p-value ≤ 0.05 considered significant. Results: Post-intervention analysis revealed significant improvements in all domains of critical thinking: interpretation (p = 0.000), analysis (p = 0.000), evaluation (p = 0.000), inference (p = 0.000), and explanation (p = 0.000). The overall mean critical thinking score increased from 15.6 ± 3.5 to 20.5 ± 2.9 (p < 0.001). Senior students (3rd and 4th year) demonstrated greater improvements compared to juniors (p = 0.034), while no significant gender-based differences were observed (p = 0.210). Conclusion: Problem-based learning significantly enhances critical thinking skills among undergraduate nursing students and should be integrated into nursing curricula in Pakistan to promote clinical competence and professional readiness.

Frequency of Coronary Artery Anomalies Among Adult Patients Undergoing Primary Percutaneous Coronary Intervention

2025-05-21T10:45:02+00:00

Coronary artery anomalies (CAAs) are congenital variations in coronary anatomy that may be encountered during primary percutaneous coronary intervention (PCI). Early recognition is critical to avoid procedural complications, especially during emergent interventions. Objective: To determine the frequency and types of CAAs in adult patients undergoing primary PCI in a tertiary care hospital in Pakistan. Methods: This descriptive cross-sectional study was conducted over six months at the Department of Cardiology, Bahawal Victoria Hospital (BVH), Bahawalpur, from 3^rd October 2024 to 3^rd April 2025. One hundred sixty-two adult patients undergoing primary PCI were included using non-probability consecutive sampling. Demographic, clinical, and angiographic data were recorded. Coronary angiograms were assessed for anomalies by two experienced interventional cardiologists. Data were analyzed using SPSS v25. Chi-square tests were applied to evaluate associations between CAAs and cardiovascular risk factors. Results: Among the 162 patients, the mean age was 58.4 ± 10.2 years, with 74.7% being male. The overall frequency of CAAs was 9.3% (n = 15). The most common anomaly was the right coronary artery (RCA) originating from the left coronary sinus (3.1%), followed by absence of the left main trunk with separate origins of the LAD and LCx arteries (2.5%). No statistically significant association was found between CAAs and hypertension (p = 0.43), diabetes mellitus (p = 0.39), smoking (p = 0.36), age > 60 years (p = 0.85), or male gender (p = 0.68). Conclusion: The frequency of CAAs in patients undergoing primary PCI in this Pakistani tertiary care setting was relatively high at 9.3%. The most frequently observed anomalies were RCA from the left coronary sinus and absence of the left main trunk. While no significant correlation was observed with traditional cardiovascular risk factors, the recognition of CAAs remains essential during emergency PCI to guide catheter selection, prevent procedural delays, and ensure patient safety.

Frequency of Helicobacter Pylori Infection Among Patients With Dyspepsia

2025-06-03T16:20:28+00:00

Helicobacter pylori (H. pylori) is a globally prevalent pathogen, infecting nearly half of the world’s population. It is strongly associated with a spectrum of gastrointestinal disorders, including chronic gastritis, peptic ulcer disease, and gastric malignancies. Early detection of H. pylori infection, particularly among dyspeptic individuals, is essential for prompt treatment and prevention of complications. Objective: To determine the frequency of Helicobacter pylori infection among patients presenting with dyspepsia at tertiary care hospitals in Quetta and Turbat, Pakistan. Methods: This descriptive cross-sectional study was conducted at the Department of Internal Medicine, Sandeman Provincial Hospital, Quetta, and the Department of Medicine, Teaching Hospital, Turbat from January 2023 to December 2023. A total of 145 adult patients presenting with clinical features of dyspepsia and fulfilling the inclusion criteria were enrolled after obtaining informed written consent. Detailed history and clinical examination were performed. Stool samples were collected from all participants and tested for Helicobacter pylori stool antigen (HPSA) using enzyme immunoassay. Data were analyzed to determine the frequency of H. pylori infection. Results: Out of 145 patients with dyspepsia, 93 (64.1%) were males and 52 (35.9%) were females. The mean age of the study population was 29.95 ± 4.71 years. H. pylori infection was detected in 99 patients, representing a prevalence of 68.3%. Infection was more common among males and individuals residing in urban areas. Conclusion: The prevalence of Helicobacter pylori infection among dyspeptic patients in this study was notably high, especially in young males and those from urban settings. These findings highlight the need for routine screening and early eradication therapy in symptomatic individuals to reduce gastrointestinal morbidity.

Comparison of Bolster Versus Quilting Techniques on Outcome of Graft Take for Free Fibula Donor Site

2025-05-31T10:51:17+00:00

Donor site management following free fibula flap harvest is crucial to optimize healing and minimize morbidity. While bolstering and quilting are both commonly employed to enhance graft adherence, their relative efficacy in donor site graft take and complication rates remains uncertain, particularly in head and neck oncologic reconstruction. Objective: This study aims to directly compare the outcomes of quilt and bolster when applied specifically to the free fibula flap donor site, in regard to graft take. Methods: After the ethical approval from the institutional review board, this Single center, parallel, open labelled, randomized control trial was conducted at Plastic Surgery Department at Aga Khan University Hospital from 01/July/2024 to 31/dec/2024. Through non-probability consecutive sampling, 48 patients aged 18-70 years, both gender, who underwent free fibula flap for reconstruction of head and neck tumors at were included in this study. Patients with prior history of limb trauma, peripheral vascular disease, underwent free fibula for other illnesses, such as osteoradionecrosis or trauma or extremity tumors were excluded from the present study. Results: The average flap donor site defect size was 93.5 ± 27.7 cm² in the bolster group and 90.4 ± 23.8 cm² in the quilting group (p = 0.649). The majority of split-thickness skin grafts (STSGs) in both groups were harvested from the contralateral leg—92% in the bolster group and 100% in the quilting group—while only 8% of STSGs in the bolster group were taken from the same leg (p = 0.162). The mean percentage of graft take was 86.2% ± 5.9 in the bolster group and 85.8% ± 7.5 in the quilting group, showing no significant difference (p = 0.812). Donor site complications were observed in 13% of patients in each group (p = 0.98), indicating comparable complication rates between the two techniques. Conclusion: Both bolstering and quilting techniques yield comparable outcomes in terms of graft take and complication rates at the free fibula donor site.

Efficacy of Vaginal Prostaglandin E2 Versus Oxytocin for Induction of Labour in Patients with Premature Rupture of Membranes

2025-05-31T09:23:55+00:00

Prelabour rupture of membranes (PROM) at term is a common obstetric complication that necessitates timely labor induction to reduce maternal and neonatal morbidity. While both oxytocin and prostaglandin E2 (PGE2) are used for induction, their comparative efficacy remains under-investigated in low-resource settings such as Pakistan. Objective: To compare the efficacy of vaginal prostaglandin E2 versus intravenous oxytocin for labor induction in patients with term PROM in terms of timely vaginal delivery and reduction in cesarean rates. Methods: A randomized controlled trial was conducted over six months from April 2024 to September 2024 at the Department of Obstetrics & Gynaecology, Ibn-e-Siena Hospital, Multan. A total of 120 women with singleton term pregnancies (37–42 weeks) presenting with PROM of <6 hours duration were randomly assigned to receive either intravenous oxytocin (Group A, n = 60) or vaginal PGE2 (Group B, n = 60). Primary outcome was vaginal delivery within 24 hours. Secondary outcomes included induction-to-delivery interval, cesarean section rate, and failure of induction. Data were analyzed using SPSS version 23, with significance set at p ≤ 0.05. Results: Vaginal delivery within 24 hours was achieved in 73.3% of women in the PGE2 group versus 50.0% in the oxytocin group (p = 0.010). The mean induction-to-delivery interval was significantly shorter in the PGE2 group (7.2 ± 2.1 hours) compared to the oxytocin group (9.4 ± 2.3 hours; p < 0.001). Cesarean section rates were also significantly lower in the PGE2 group (20.0%) versus the oxytocin group (40.0%; p = 0.020). No serious adverse events were reported in either group. Conclusion: Vaginal PGE2 is more effective than intravenous oxytocin for labor induction in term PROM, with a higher likelihood of timely vaginal delivery and reduced cesarean risk. These findings support the inclusion of PGE2 in national labor induction guidelines, especially in high-volume, resource-limited healthcare settings in Pakistan.

Risk Factors of Postpartum Urinary Retention After Vaginal Delivery: A Case-Control Study

2025-05-31T07:35:28+00:00

PPUR is a common yet underdiagnosed complication of vaginal delivery, especially in low-resource settings. Objective: This study aimed to identify maternal and intrapartum risk factors associated with PPUR. Methods: A case-control study was conducted at Ibn-e-Siena Hospital, Multan, over three months from 22 January 2025 to 22 April 2025. A total of 142 women (71 with PPUR, 71 controls) were assessed for maternal characteristics and intrapartum variables. Statistical analysis included logistic regression to identify independent risk factors. Results: Significant independent risk factors for PPUR included episiotomy (OR 3.90), epidural analgesia (OR 3.88), obesity (OR 2.54), gestational diabetes (OR 3.39), macrosomia (OR 4.75), and longer labor duration (p = 0.003) were noted in this study. Conclusion: Targeted monitoring for women with identified risk factors may reduce the incidence and complications of PPUR. These findings support the integration of routine bladder care into postpartum protocols in Pakistani healthcare settings.

Clinical Outcome of Conservative Management of Acute Appendicitis

2025-05-25T09:26:38+00:00

Conservative management of uncomplicated acute appendicitis using antibiotics has gained global interest as a safe alternative to surgery. This approach is especially relevant in resource-limited healthcare systems like Pakistan, where surgical capacity and accessibility remain constrained. This study aimed to evaluate the clinical outcomes of non-operative management in patients with uncomplicated acute appendicitis in a Pakistani tertiary care setting. Methods: This prospective observational study was conducted at a PIMS hospital in Islamabad from 9 November 2024 to 9 February 2025. Patients were treated conservatively with intravenous antibiotics followed by oral antibiotics. Primary outcomes included symptom resolution, recurrence within six months, and the need for delayed appendectomy. Secondary outcomes included hospital stay duration, complications, and readmission rates. Data were analyzed using SPSS version 26.0. Results: Symptom resolution was achieved in 86.2% of patients within 48 hours. During initial admission, 94.3% were successfully managed without surgery. At six-month follow-up, 80.5% remained symptom-free. In 13.8% of patients, recurrence occurred, while 11.5% required delayed appendectomy. Complication and readmission rates were low (3.4% and 6.9%, respectively), and the mean hospital stay was 3.8 days. Conclusion: Conservative management of uncomplicated acute appendicitis is a safe and effective alternative to surgery in selected patients. This approach may reduce hospital burden, lower healthcare costs, and minimize surgical risks in the Pakistani healthcare context.

Awareness and Knowledge of Liver Diseases in Relation to Demographic Variables in the General Population of Pakistan

2025-05-21T11:11:38+00:00

Liver diseases are a growing public health concern worldwide, yet public awareness and understanding of these conditions remain inadequate. Objectives: To assess the level of awareness and knowledge regarding liver diseases among patients and examine how these vary according to demographic factors such as age, gender, education, and residence. Methods: This cross-sectional, observational study was conducted at the Gastroenterology Outpatient and Indoor departments at Combined Military Hospital Lahore from 1^st February 2025 till 30^th April 2025. All patients meeting the inclusion criteria will be asked to fill out a standard questionnaire, the regional liver index study, and some questions from previously done research assessing the patients' knowledge, attitude, and practice regarding chronic liver disease. Data were collected using a structured questionnaire. Results: Out of 200 participants, 75% reported general awareness of liver diseases, with hepatitis being the most recognized condition (60%). However, only 19% of respondents demonstrated good knowledge, while 43% and 38% had moderate and poor knowledge. Knowledge levels were significantly associated with education level (p < 0.001) and place of residence (p = 0.03), but not with gender (p = 0.22). Only 28% were aware of the hepatitis B vaccine. Traditional media and the internet were the most cited sources of information. Conclusion: It is concluded that although awareness of liver diseases exists among the population, specific knowledge remains limited, particularly among individuals with lower educational levels and those in rural areas. Targeted educational initiatives are needed to bridge this knowledge gap and improve liver health outcomes.

Impact of Different BMIs on Fetomaternal Outcome as Compared to Control Group BMIs

2025-06-08T17:45:18+00:00

Maternal body mass index (BMI) plays a pivotal role in determining fetomaternal outcomes. Deviations from the normal BMI range—whether underweight, overweight, or obese—are associated with adverse maternal and neonatal complications. As the global prevalence of abnormal BMI among women of reproductive age continues to rise, it is imperative to understand its impact on pregnancy outcomes to optimize prenatal care strategies. Objective: To evaluate and compare the fetomaternal outcomes across different maternal BMI categories—underweight, overweight, and obese—using women with normal BMI as the reference group, with a focus on maternal complications (e.g., pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), postpartum hemorrhage (PPH)) and neonatal indicators (e.g., birth weight, NICU admission). Methods: This cross-sectional observational study was conducted over six months at the Combined Military Hospital (CMH), Quetta from July 2023 to January 2024. A total of 200 third-trimester pregnant women with singleton pregnancies were selected via purposive sampling and stratified equally into four BMI categories—underweight, normal (control), overweight, and obese—based on World Health Organization (WHO) BMI criteria. Data on mode of delivery, maternal complications, and neonatal outcomes were collected using clinical records and semi-structured interviews. Statistical analysis involved the use of frequencies, percentages, and thematic content analysis to assess psychological factors. Results: Obese women exhibited the highest rates of cesarean delivery (48%), GDM (30%), PIH (24%), macrosomia (20%), and NICU admissions (28%). Overweight women also demonstrated increased risks across these categories, though to a slightly lesser degree. Underweight mothers had the highest incidence of low birth weight (36%), notable NICU admissions (12%), and assisted vaginal delivery (8%). Women with normal BMI consistently showed the most favorable outcomes across all variables. Thematic analysis revealed psychological distress related to body image, fear of surgical interventions, and reduced emotional support, especially among underweight and obese participants. Conclusion: Abnormal maternal BMI is significantly associated with poor fetomaternal outcomes. Underweight status predisposes to intrauterine growth restriction and neonatal morbidity, while obesity increases the risk of metabolic, hypertensive, and delivery-related complications. Optimal pregnancy outcomes are most consistently observed in women with normal BMI. These findings highlight the need for BMI-based prenatal risk stratification, targeted counseling, and integrated psychosocial support to improve maternal and neonatal health.

Comparison Study Of Minimally Invasive Plate Osteosynthesis (MIPO) Vs Open Reduction And Internal Fixation (ORIF) For Comminuted Distal Tibia Fracture

2025-05-31T12:19:17+00:00

Comminuted distal tibia fractures are complex injuries that require precise management due to limited soft tissue coverage and high risk of complications. Two commonly used fixation techniques are minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF). Each method has distinct biomechanical and biological implications that influence healing outcomes. Objective: To compare the functional and radiological outcomes of MIPO versus ORIF in the treatment of comminuted distal tibia fractures. Methods: This prospective comparative study was conducted at the Department of Orthopedic Surgery, CMH Rawalpindi, from 15 June 2024 to 14 Feb 2025. A total of 60 patients were divided into two groups of 30 each, treated with either MIPO or ORIF. Functional outcomes were measured using the AOFAS score, and radiological union was assessed through serial X-rays. Results: The MIPO group showed significantly higher mean AOFAS scores (88.5 vs. 80.9), faster union times (15.2 vs. 17.6 weeks), and fewer complications compared to the ORIF group. Conclusion: MIPO is a superior technique for comminuted distal tibia fractures, offering better outcomes with fewer complications.

Comparison of Functional Outcome After 2 Weeks Immobilization Versus No Immobilization After Reduction of Acute Shoulder Dislocation

2025-05-31T09:55:09+00:00

Acute anterior shoulder dislocation is an injury that happens mostly in people who are active and younger. After reducing the dislocation, immobilizing the joint is an accepted treatment, but the ideal time for removal is argued, since some studies report that early movement may help you recover faster. Objective: To analyze whether resting the shoulder is better than moving it after a closed reduction for first-time anterior shoulder dislocation. Methods: The study was carried out in the Orthopedic Surgery Department of CMH Rawalpindi between 15 June 2024 to 14 Feb 2025. The study grouped sixty patients into two groups. Group A was repaired and then confined to bed for two weeks; Group B was not immobilized and was encouraged to move as soon as possible. Constant-Murley and DASH scores were used to measure function at 2, 6, and 12 weeks after reducing the fracture. Results: Group B consistently had better mean scores for Constant-Murley and DASH at 6 and 12 weeks, with p < 0.01 (statistical significance). No differences in rates of redislocation were noticed between the groups. Conclusion: Early mobilization without immobilization after anterior shoulder dislocation results in superior short-term functional outcomes and may be a viable alternative to traditional immobilization.