Biological and Clinical Sciences Research Journal

Challenges and Success: General Anaesthesia for Re-Do Spine Surgery in an Elderly Woman With Sepsis, Pulmonary Hypertension, and Hemodynamic Instability on Positioning for Surgery: A Case Report

2026-01-01T18:10:01+00:00

Geriatric patients exhibit reduced physiological reserve due to age-related organ system changes, predisposing them to increased perioperative morbidity and mortality, particularly in the presence of multiple comorbidities and sepsis. Objective: To highlight perioperative anaesthetic challenges and management strategies in a high-risk geriatric patient with complex comorbidities undergoing surgery. Methods: This case report describes a 95-year-old female with hypothyroidism, rheumatoid arthritis, valvular heart disease, and pulmonary hypertension who developed myocardial infarction, urinary tract infection, and surgical site infection following microendoscopic spine surgery. She was planned for wound debridement after comprehensive preoperative optimisation. Detailed cardiovascular evaluation was performed, and invasive hemodynamic monitoring was instituted. Intraoperative anaesthetic management focused on maintaining hemodynamic stability, avoiding factors that increase pulmonary vascular resistance, and ensuring vigilant monitoring throughout the perioperative period. Results: During surgery, the patient developed complete heart block while positioned prone, necessitating immediate application of transcutaneous pacing pads and modification of surgical positioning. Prompt recognition and intervention prevented further hemodynamic deterioration. The procedure was completed safely under close monitoring without progression to cardiac arrest or severe instability. Conclusion: Careful preoperative optimisation, invasive monitoring, and prompt intraoperative decision making are crucial in elderly patients with severe comorbidities. Individualised anaesthetic planning and avoidance of precipitating factors for pulmonary vasoconstriction can significantly improve perioperative outcomes in this vulnerable population.

Improving Adherence to WHO Surgical Hand Preparation Guidelines in Elective Operating Theatres of a Teaching Hospital in Gujrat, Pakistan: A Completed Audit Cycle

2025-12-31T11:41:45+00:00

Surgical hand preparation is a core infection prevention practice for reducing surgical site infection risk. This audit assessed adherence to World Health Organization (WHO) recommended surgical hand preparation steps and evaluated the effect of a structured improvement package. Methods: A prospective observational audit was conducted in the elective operating rooms of Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan. A 16-item checklist adapted from WHO guidance covered pre-scrub preparation, hand and forearm washing, rinsing, drying, and final aseptic steps. Compliance was calculated as the percentage of checklist items correctly performed per scrubbing episode. After baseline observation (pre-intervention), corrective measures were implemented (targeted training, visual reminders, and distribution of a standard operating protocol), and a re-audit was performed. Results: A total of 85 surgical hand preparation episodes were observed at baseline and 85 at re-audit across surgery, orthopaedics, and neurosurgery teams. Overall mean compliance improved from 56.9% (SD 11.9) pre-intervention to 89.2% (SD 8.7) post-intervention, an absolute increase of 32.3 percentage points. At baseline, 0% achieved at least 94% compliance (>=15 of 16 items); post-intervention, 47.1% achieved this threshold, and 20.0% completed 100% compliance. Conclusion: Baseline adherence to WHO surgical hand preparation steps was suboptimal. A simple, low-cost quality improvement package was associated with marked improvement across roles and specialties. Ongoing education, supervision, and periodic re-audits are recommended to sustain gains.

Assessment of Knowledge Regarding Pregnancy-Induced Hypertension Among Women

2026-01-05T17:05:45+00:00

Pregnancy-induced hypertension (PIH) is a major contributor to maternal and perinatal morbidity. In Pakistan, limited awareness and delayed care seeking may worsen outcomes; assessing maternal knowledge is essential for targeted antenatal education. Objective: To assess the level of knowledge regarding pregnancy-induced hypertension among pregnant women attending antenatal care at a tertiary care hospital in Lahore, Pakistan. Methods: A descriptive cross-sectional study was conducted in the gynecology outpatient department of a tertiary care hospital in Lahore. Pregnant women at or beyond 20 weeks of gestation with documented blood pressure ≥140/90 mmHg on at least two occasions (4 hours apart) and no prior history of chronic hypertension were included; women with pre-existing hypertension and selected chronic illnesses (eg, diabetes, renal disease) were excluded. Sample size (n = 187) was calculated using Slovin's formula (estimated population 350; margin of error 5%), and participants were recruited through convenience sampling. Data were collected via a structured, adapted questionnaire (translated into Urdu) administered through face-to-face interviews. Data were analyzed in SPSS version 21 using descriptive statistics (frequencies and percentages). Results: Among 187 women, most were aged 23 to 27 years (40.1%); 89.8% were from urban areas, 52.4% were illiterate, 91.4% were homemakers, and 60.4% were multigravida. A physician's diagnosis of hypertension in the current pregnancy was reported by 77.0%. Complications related to hypertensive disorders (preeclampsia/eclampsia/toxemia) were reported by 65.8%, and 54.5% reported proteinuria or severe PIH. At assessment, 46.0% were currently hypertensive, while 48.7% reported taking antihypertensive medication. Knowledge assessment showed that 60.4% had no awareness of high blood pressure and its implications in pregnancy; 49.7% reported a family history of hypertension. Conclusion: A substantial knowledge gap regarding PIH was observed among pregnant women receiving antenatal care, alongside a high burden of reported complications. Strengthening focused health education and counseling during antenatal visits may improve early recognition and timely care seeking for hypertensive disorders of pregnancy.

Frequency of Depression in Patients With Diabetes Mellitus Presenting to DHQ Kohat

2026-01-01T07:26:26+00:00

Depression is a common but underrecognized comorbidity in patients with diabetes mellitus and adversely affects glycemic control, treatment adherence, and overall quality of life. Objective: To determine the frequency of depression in patients with diabetes mellitus presenting to DHQ Kohat. Methods: This study was conducted in 213 diabetic patients aged 18 to 75 years with HBA1c> 6.5%. The frequency of depression in these diabetic patients was determined. Depression was diagnosed using the PHQ-9 tool and DSM-IV. SPSS 27 was used for analysing the data. Depression was stratified by various demographic and comorbidities using the chi-square test, with a P-value set at ≤ 0.05. Results: The mean age of the patients was 44.62 ± 16.45 years. There were 133 (62.4%) male and 80 (37.6%) female patients. The frequency of depression was 37.6% (n = 80). Depression was significantly associated with female gender, lower economic background, poor glycemic control, hypertension and prolonged diabetes duration. Conclusion: The frequency of depression in patients with diabetes mellitus in our study was 37.6%, and it was notably associated with female gender, lower economic background, poor glycemic control, hypertension and prolonged diabetes duration.

Outcomes of Intramedullary Nail Without Locking in Patients Aged 10-16 Years Having Closed Femoral Shaft Fracture

2025-12-27T07:28:33+00:00

Femoral shaft fractures in school-aged children and adolescents pose therapeutic challenges due to growth considerations and the need for early mobilization. Flexible intramedullary nailing without locking has emerged as a minimally invasive option with favorable outcomes. Objective: To assess the functional outcomes of intramedullary nail without locking in patients aged 10-16 years having closed femoral shaft fractures. Methodology: This study was conducted on a cohort of 70 patients aged 10 to 16 years presenting with closed femoral shaft fractures from August 2024 to August 2025 at the Department of Orthopedic Surgery, Hayatabad Medical Complex, Peshawar. All patients underwent closed reduction and internal fixation with a flexible intramedullary nail system without interlocking screws. Functional outcome was assessed at three-month follow-up using Flynn's TEN criteria, which categorise outcomes as excellent, good, and fair. SPSS 25 was used for analysis. Results: The mean age of 70 patients was 12.74 years. The majority of the patients were male, 64.3%. Functional outcomes were excellent in 46 cases (65.7%), good in 19 cases (27.1%), and fair in 5 cases (7.1%). Postoperative complications were skin irritation (4.3%) and limb length discrepancy (2.9%). A statistically significant association was found between functional outcome and complication status. Conclusion: Non-locking intramedullary nailing is an effective and safe surgical procedure for closed femoral shaft fractures in children aged 10–16 years. The procedure exhibited a high rate of excellent functional outcomes and a lower incidence of complications.