Biological and Clinical Sciences Research Journal

Correlation of Serum Sodium with Severity of Hepatic Encephalopathy in Liver Cirrhosis Patients Presenting at Tertiary Care Hospital, Lahore

Aleena Ali — 2025-02-28

Hepatic encephalopathy (HE) is a serious complication of liver cirrhosis, characterized by cognitive impairment and neurological dysfunction. Emerging evidence suggests that hyponatremia plays a critical role in the pathophysiology of HE, potentially exacerbating its severity. However, the relationship between serum sodium levels and the severity of HE remains an area of ongoing investigation. Objective: To evaluate the correlation between serum sodium levels and the severity of hepatic encephalopathy in cirrhotic patients. Methods: This descriptive cross-sectional study was conducted at the Department of Gastroenterology, Doctors Hospital and Medical Center, Lahore, over a period of six months. A total of 120 patients diagnosed with HE were enrolled using non-probability consecutive sampling. Clinical history, laboratory investigations, and serum sodium levels were documented. The severity of HE was graded using the West Haven classification system. Pearson’s rank correlation test was applied to assess the relationship between serum sodium levels and HE severity, and the Chi-square test was used to evaluate categorical associations. Data analysis was performed using SPSS Version 24, with a p-value of ≤0.05 considered statistically significant. Results: Among the 120 patients, 55 (45.8%) were men and 65 (54.2%) were women, with a mean age of 59.84 ± 7.93 years. Hyponatremia (serum sodium <135 mEq/L) was present in 99 patients (82.5%). A statistically significant inverse correlation was observed between serum sodium levels and the severity of HE (Pearson’s R = -0.285, p = 0.002). Additionally, the Chi-square test confirmed a strong association (p < 0.001) between hyponatremia and HE severity. Conclusion: Hyponatremia is significantly correlated with increased severity of hepatic encephalopathy in cirrhotic patients. Routine monitoring of sodium levels and early corrective interventions may help prevent HE progression and improve patient outcomes. Further research is required to assess the prognostic implications of hyponatremia in HE management.

Maternal and Neonatal Outcomes after Planned or Emergency Delivery for Placenta Accreta Spectrum

Simab Sajid — 2025-02-28

For the mother, placenta accreta spectrum is a fatal disorder that frequently causes significant blood loss. So, proper management and care are vital to prevent adverse outcomes. Objective: This study aimed to determine the Maternal and Neonatal Outcomes after Planned or Emergency Delivery for Placenta Accreta Spectrum. Methodology: The current cross-sectional descriptive Study was conducted at the Department of Gynecology and Obstetrics, Sheikh Zayed Hospital and Medical College, Rahim Yar Khan, over 6 months. Total 30 women fulfilling the inclusion criteria from the in-patient department of obstetrics and gynecology, SZH RYK were included in the study. Depending on delivery, planned or emergency caesarean delivery, the women were divided into two groups and were followed up for the Maternal & neonatal Outcome. Data were entered into and analyzed using SPSS-24. Results: 30 women with Placenta accreta spectrum were included in the current study. Among them 20(66.6) underwent planned and 10(33.33%) emergency caesarean delivery. The basic maternal characteristics were not significantly different between the two groups; however, the women who had emergency caesarean delivery had a high parity and a lower BMI (P ˂0.05). The group that had an emergency delivery had a considerably larger percentage of women who experienced antepartum haemorrhage (50% P <.001). The median gestational ages at which emergency deliveries occurred were noticeably lower (value of p less than 0.001). Nonetheless, women having an emergency delivery had a greater risk of maternal ICU admissions (value of P.02). We compared neonatal outcome in both groups the admission to intensive care unit in Emergency delivery was higher (48%) as compared to planned delivery (15%) (P value <0.001) Conclusion: Our study concluded that emergency deliveries did not result in higher rates of maternal morbidity, transfusions, or blood loss. Antenatal haemorrhage was the single biggest risk factor for emergency delivery. Emergency delivery increased the risk of maternal and neonatal ICU admissions.

Frequency And Predictors of Acute Kidney Injury in Patients With Decompensated Liver Cirrhosis

Amar-un- nisa — 2025-02-28

Acute kidney injury (AKI) is a common and life-threatening complication in patients with decompensated liver cirrhosis, leading to increased morbidity and mortality. Identifying risk factors for AKI in cirrhotic patients is crucial for early intervention and better clinical outcomes. However, limited data exist regarding the prevalence and predictors of AKI in decompensated cirrhotic patients in Pakistan. Objective: This study aimed to determine the prevalence, risk factors, and clinical impact of AKI in patients with decompensated liver cirrhosis admitted to a tertiary care hospital in Pakistan. Methods: A cross-sectional study was conducted at the Department of Medicine, Ibn-e-Sina Hospital, Multan, over six months (April 2024 to November 2024). A total of 121 patients with decompensated liver cirrhosis were enrolled using non-probability consecutive sampling. AKI was diagnosed based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Data on demographics, comorbidities, medication use, and laboratory parameters were collected and analyzed using SPSS version 25. Statistical tests, including the chi-square test and logistic regression, were used to determine the association between risk factors and acute kidney injury (AKI). A p-value < 0.05 was considered statistically significant. Results: The incidence of AKI was 34.7% (42/121). The mean Child-Pugh-Turcotte (CPT) score was significantly higher in AKI patients (11.6 ± 2.1) compared to non-AKI patients (9.8 ± 2.0, p<0.001). Diabetes mellitus (60% vs. 30%, p=0.002) and nephrotoxic drug use (43% vs. 21%, p=0.01) were significant predictors of AKI. Logistic regression analysis showed that diabetes (OR=2.8, 95% CI: 1.4-5.6, p=0.002), nephrotoxic drug use (OR=2.5, 95% CI: 1.2-5.2, p=0.01), and CPT score ≥10 (OR=3.9, 95% CI: 1.9-8.0, p<0.001) were independent predictors of AKI. Conclusion: AKI is prevalent in patients with decompensated liver cirrhosis, with higher CPT scores, diabetes mellitus, and nephrotoxic drug use identified as key risk factors. Early identification and implementation of preventive strategies are crucial for improving renal outcomes in patients with cirrhosis. Further prospective studies are recommended to validate these findings and develop evidence-based management guidelines.

Incidence, Impact, and Causes of Presenteeism in Nurses at a Tertiary Care Hospital

Madeha Arshad — 2025-02-28

Presenteeism, defined as attending work despite illness or other conditions that hinder productivity, is a growing concern in healthcare settings. It can negatively impact patient care, increase the risk of medical errors, and contribute to burnout among nurses. Understanding the prevalence, causes, and consequences of presenteeism in nurses is crucial for designing effective workplace policies and interventions. Objective: To assess the incidence, impact, and causes of presenteeism among nurses working at a tertiary care hospital. Methodology: A cross-sectional study was conducted in the Nursing Department of Medicare Hospital, Multan, from January 2024 to January 2025. Nurses employed for at least the past 12 months were included. Data were collected using a structured questionnaire divided into four sections: demographic details, the Sickness Presenteeism Questionnaire, work productivity loss assessment, and causes of presenteeism. Statistical analysis was performed using SPSS Version 25, with significance at p<0.05. Results: The mean presenteeism score was 2.68 ± 0.88, with 95% of nurses experiencing presenteeism in the last six months. Significant differences were observed across age groups (t = -2.28, p = 0.03), work experience (t = -5.03, p = 0.00), and marital status (t = -2.09, p < 0.05). The primary causes of presenteeism included excessive workload (65%), insufficient leave policies (65%), conscientiousness (60%), and financial constraints (55%). Conclusion: The study revealed a high incidence of presenteeism among Pakistani nurses, significantly associated with age, social status, and work experience. Key contributing factors included excessive workload, lack of adequate leave, financial pressures, and a sense of professional responsibility. Addressing these challenges through improved staffing, better leave policies, and workplace wellness initiatives may help mitigate presenteeism and enhance nurse well-being and patient safety.

Adherence Towards Ventilator Associated Pneumonia Guidelines of Nurses Working in Critical Care

Hina Zahra — 2025-02-28

Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality in critically ill patients. Nurses' adherence to VAP prevention guidelines plays a critical role in reducing the incidence of this infection. However, various institutional and personal barriers can impact compliance rates in clinical settings. Objective: To assess the adherence of critical care unit (CCU) nurses to ventilator-associated pneumonia (VAP) guidelines and identify factors influencing this adherence. Methods: A cross-sectional study was conducted in the Critical Care Department of Medicare Hospital, Multan, from January 2024 to January 2025. A total of 100 nurses working in the ICU and CCU departments were included in this study, which employed convenience sampling. Data were collected using a structured questionnaire consisting of three parts: demographic information, VAP guideline adherence (scored on a validated scale), and perceived barriers to compliance. Statistical analysis was performed using SPSS version 25. Mean adherence scores were compared across different variables using appropriate statistical tests, with a significance level set at p < 0.05. Results: The mean adherence score was 28.9 ± 4.04 (range: 17–34). Among the participants, 25% demonstrated good compliance, 30% satisfactory compliance, and 45% poor compliance with VAP guidelines. Significant barriers identified included staff shortage (70%), forgetfulness (65%), cost-control policies (60%), outdated education (44%), and fear of poor patient outcomes (42%). Nurses managing more than 20 ICU beds had adherence scores 8.0 points higher than those working fewer than 10 beds (p < 0.001). Additionally, nurses with prior education on VAP guidelines scored 0.8 points higher than their counterparts. Conclusion: Adherence to VAP guidelines among ICU nurses is suboptimal, with a significant proportion demonstrating poor compliance. Higher adherence was associated with more enormous ICU responsibilities and prior education on VAP. Institutional policies aimed at improving staffing levels and ongoing VAP education may enhance compliance and improve patient outcomes.

Diagnostic Accuracy of Placenta Accreta Spectrum Scoring System (Pass Scoring) on MRI For Antenatal Diagnosis of Placenta Accreta Spectrum

Sheeza Jabeen — 2025-02-28

To decrease the chances of misdiagnosis of the placenta accreta spectrum, a scoring method must be developed based on the MRI features and the clinical presentation of patients. Objective: To determine the diagnostic accuracy of PAS-system on MRI to diagnose the placenta accreta spectrum, considering per operative findings after cesarean section as gold standard Study design: It was a cross sectional validation study Methods: The study was executed from Dec 2022 to Jun 2023 at Department of Radiology, Holy Family Hospital, Rawalpindi. Pregnant females of 2nd or 3rd trimester, aged 20-45 years, suspected for placenta accreta spectrum based on ultrasound, or those at high-risk for placenta accreta spectrum were included. Magnetic resonance imaging scan was conducted for all enrolled participants on a 1.5T scanner (Model MRI 450w optima). The MRI findings were then matched with the final diagnosis made based on the operative findings during cesarean section for all the patients. The diagnostic accuracy was evaluated in terms of sensitivity and specificity. Results: There were 95 participants whose mean age was 30.59±3.7 years, with an age range of 21-40 years. Around 50 (52.6%) belonged to the age group of 20 to 30. A sensitivity of 88.0%, specificity of 91.1%, positive predictive value of 91.6%, negative predictive value of 87.2% and diagnostic accuracy of 89.4% was reported. Conclusion: The PAS scoring system based on MRI for PAS is a highly sensitive and accurate imaging modality.

Role of Video laryngoscopy in the Management of Difficult Airway in Modern Anaesthesiology: A Survey

Sadam Hussain — 2025-02-28

In patients with anticipated difficult airway, video laryngoscopy (VL) has shown improved laryngeal view, higher success rates, and higher first-attempt success, leading to fewer intubation maneuvers in VL. Objective: To determine the availability, usage factors, restrictions, and preferences of video laryngoscopes in difficult airway management among anesthesiologists in Sindh. Methods: A total of 94 participants were included. A questionnaire was used, which was divided into two parts. The first part contained questions regarding demographic data and difficult airway management. The second part addressed the availability, use, and perception of anesthesiologists toward its use. The data were compiled and analyzed using SPSS version 25. The Shapiro-Wilk test was used to check normality. If the data were non-normal, the median (IQR) was reported. Stratification was performed and post-stratification chi-square or Fisher's exact tests were applied, with a P-value <0.05 considered significant. Results: The mean age of the anesthesiologists was 32.46±5.88 years. The majority (83%, n=78) of participants reported having access to video laryngoscopy. A total of 3 (3.2%) anesthesiologists faced restrictions. The high expense was the reason for not using VLs. First-generation LMA (48.9%), video laryngoscopy (64.9%), and fibreoptic bronchoscopy (42.6%) were the most preferred first, second, and third options for managing the anticipated difficult airways. Conclusion: Most respondents had access to VLs. A very low percentage of participants faced restrictions in using VLs. The high cost of the device is the primary barrier to its use.

Frequency of Extensively Drug Resistant Typhoid Fever in Children Aged 4-16 Years at Pediatrics Unit of Khyber Teaching Hospital

Syeda Aminah Shah — 2025-02-28

Extensively drug-resistant (XDR) enteric fever is a growing public health concern, particularly in pediatric populations. The increasing resistance to multiple antibiotics limits treatment options and complicates disease management. Identifying demographic and clinical factors associated with XDR enteric fever is crucial for improving early diagnosis and intervention strategies. Objectives: This study aimed to determine the frequency of extensively drug-resistant (XDR) enteric fever in pediatric patients and identify associated demographic and clinical factors. Methodology: Over six months, a cross-sectional study was conducted at Khyber Teaching Hospital, Peshawar. Children aged 4–16 years with prolonged fever (>40°C for >1 week), abdominal pain (VAS >3), and malaise were included. Diagnosis was confirmed by positive blood cultures for Salmonella enterica serovar Typhi. XDR enteric fever was defined as resistance to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, ceftriaxone, and fluoroquinolones. Consecutive non-probability sampling was used, and data were analysed using SPSS version 20. Results: Among 136 participants, the mean age was 9.85 ± 3.76 years, and 57.4% were male. XDR enteric fever was identified in 44.9% (n=61) of cases. Males accounted for 68.9% of XDR cases, while females represented 31.1%. Lower socioeconomic status (49.2%) and rural residence (57.4%) were significantly associated with XDR typhoid (p<0.0001). Prolonged fever duration (>15 days) was observed in 55.7% of XDR cases compared to 25.3% of non-XDR cases (p<0.0001). Conclusion: XDR enteric fever is prevalent among pediatric patients, particularly in males, lower socioeconomic groups, and rural residents. Prolonged fever duration is a significant risk factor.

Prevalence and Risk Factors of PSTD in Nurses Working in Intensive Care Unit

Nida Rasheed — 2025-02-28

Nurses working in intensive care units (ICUs) are exposed to high-stress environments, making them vulnerable to psychological distress, including post-traumatic stress disorder (PTSD). Identifying the incidence and associated risk factors of PTSD in ICU nurses is crucial for developing effective mental health interventions. Objective: To assess the incidence and risk factors of post-traumatic stress disorder in nurses working in the intensive care unit. Methods: A cross-sectional study was conducted in the Intensive Care Unit of Medicare Hospital, Multan from January 2024 to January 2025. A total of 100 registered nurses working in the ICU for at least 1 year were included in the study. Data was collected through questionnaires. Post-traumatic stress disorder was evaluated by the PTSD Checklist-Civilian Version. Burnout was assessed by a 22-item Maslach Burnout Inventory including questions about exhaustion, personal fulfillment, and depersonalization. A 25-item Connor-Davidson Resilience Scale to measure resilience, optimism and self-improvement. A 10-item Social Support Rating Scale was used to evaluate objective and subjective support and support utilization. Results: Among 100 nurses, the prevalence of PTSD was 20%. The mean PTSD score was 30.68 ± 10.16 with a minimum score was 10 and a maximum score of 55. The overall burnout score was 57.71 ± 7.07, 9.64 ± 2.45 for depersonalization, 23.53 ± 3.72 for exhaustion, and 26.71 ± 3.39 for personal accomplishment. There were significant differences between health status, experience, age, resilience score, and social support score in PTSD-positive and negative nurses (p<0.05). Multivariate analysis showed that burnout was independently associated with the incidence of PTSD (p=0.003) and resilience served as a protective factor. Conclusion: There is a high prevalence of PTSD among ICU nurses with burnout as an independent risk factor and resilience as a protective risk factor.

Effect of Antenatal Counselling on The Uptake of Immediate Postpartum Long Acting Reversible Contraception: A Randomized Controlled Trial At A Tertiary Care Hospital

Zoya Mushtaque — 2025-02-28

Long-acting reversible contraception (LARC) is a highly effective method of family planning, particularly in the immediate postpartum period. However, uptake remains suboptimal due to various systemic and individual barriers. Structured antenatal counseling has been proposed to improve LARC acceptance, but its impact requires further investigation. Objective: To compare the frequency of LARC uptake in the immediate postpartum period among women who received structured antenatal counseling versus those who did not. Additionally, to identify barriers to LARC uptake in both groups. Methodology: This prospective study was conducted at Al-Nafees Medical College and Hospital. Following ethical approval, 160 women meeting the inclusion criteria were randomly assigned to either the intervention group (received at least two structured antenatal counseling sessions) or the control group (no structured counseling). Counseling sessions covered LARC types, benefits, and side effects, with spouse or family participation encouraged. LARC uptake was recorded within 24 hours post-delivery, and barriers to uptake were documented. Data were collected via a structured questionnaire and analyzed using SPSS Version 25. Results: The mean age of participants was 29.73 ± 4.91 years, with a mean inter-pregnancy interval of 20.95 ± 4.25 months. The majority (53.1%) were aged 18-30 years, with 43.1% illiterate and 66.3% homemakers. A combined family system was prevalent (71.3%), and 53.1% lived in urban areas. LARC uptake was 66.9%, highest in the intervention group (70.0%) compared to the control group (63.8%), though the difference was not statistically significant. Common barriers included device unavailability (21.3%) and cost (5.6%). The presence of family during counseling significantly increased LARC acceptance in the control group, while systemic factors like device availability and provider training remained significant obstacles. Conclusion: Structured antenatal counseling improves postpartum LARC uptake, emphasizing its importance in maternal healthcare. Addressing systemic barriers, such as device availability and provider training, alongside routine counseling integration into antenatal care, can enhance contraceptive use and maternal health outcomes. Further large-scale studies are recommended to validate these findings.

Urinary Incontinence in Postmenopausal Women: Assessment of Factors Responsible

Wajeeha Khurshid — 2025-02-28

Postmenopausal women frequently experience urinary incontinence (UI), a condition often overlooked due to social stigma and lack of awareness. This study aimed to assess the risk factors that contribute to the development of urinary incontinence in postmenopausal women. Objective: To determine the risk factors associated with the development of urinary incontinence in postmenopausal women. Methods: This is a cross-sectional study conducted at the Uro-Gynae Unit of Ayub Teaching Hospital, Abbottabad, on 126 patients, following approval from the Ethical Committee of Ayub Teaching Hospital, using a non-probability consecutive sampling technique. Data was collected through face-to-face interviews on a self-structured questionnaire. Analysis was conducted using IBM SPSS-22. Results: Among 126 postmenopausal women having urinary incontinence, 93.65% were multi-parous, and 38.10% had a BMI over 30. LMP was 1‒5 years ago in 44.44% of participants. In contrast, 55.55% of women had a history of urinary tract infections, 37.30% had a history of previous surgeries, and 27.78% were using medications such as diuretics and sedatives. Family history of UI was found in 22.22% of participants. Conclusion: Factors responsible for UI in this study are multi-parity, BMI>30, UTI, previous surgery, medication, and family history of UI. There is a need to implement measures and interventions to reduce these factors.

Adherence To Practice Guidelines For Erector Spinae Plane Block-Catheter Based Analgesia In Thoracic Surgery Patients

Sami Ur Rehman — 2025-02-28

In thoracic surgery, effective postoperative pain management is crucial to enhance recovery and reduce complications. Erector spinae plane block (ESPB) has gained recognition as a promising regional analgesic technique due to its safety, ease of administration, and minimal complications. However, variations in its utilisation, catheter placement techniques, local anesthetic concentrations, and infusion rates remain an area of clinical interest. Objective: This study aims to scrutinise the utilisation of ESPB-catheter based analgesia practice in thoracic surgery patients, techniques, complications and different concentrations and volumes of local anesthetics used for pain relief.Study design: Clinical practice article/Clinical Audit. Study Place and Duration: 2.5 years from 1st January 2022 to 30th June 2024 in Doctors Hospital and Medical Centre (DHMC) operation theatres, Lahore, Pakistan. Methodology: A total of 76 patients were included in the study. All captured data was recorded manually and then presented as frequencies (percentages) in Microsoft Word Office 365 tabulated form. All calculations were done manually. Results: 76 erector spinae plane block related catheters were inserted in thoracic surgery patients. Tuohy’s needle was used for ESPB. Mean needle depth was 5cm and mean catheter depth was 11cm. Different concentrations of local anesthetics were used (0.1%, 0.2% and 0.25%) at different infusion rates (10ml/hour up to 20ml/hour). No complication was encountered during our study period. Conclusion: Erector Spinae Plane Block provides the best pain relief with minimum complication risks and maximum postoperative benefits, including its use in patients with coagulopathy and systemic infections. So, ESPB catheter-based analgesia with continuous infusion (0.15 or 0.2% bupivacaine at 15-20ml/hour) should be the preferred mode of postoperative analgesia after thoracic surgery. The catheter can be kept for a maximum of 6 days. Hence, a collaborative approach is required between the thoracic surgeon and the anesthetist.

Stroke Pattern In Diabetic Vs Non-Diabetic Patients

Muhammad Kashif Habib — 2025-02-28

Stroke is a leading cause of morbidity and mortality worldwide, with diabetes mellitus being a major risk factor influencing stroke patterns. Understanding the differences in stroke types and associated risk factors in diabetic and non-diabetic patients can help optimize prevention and management strategies. Objective: This study aimed to compare stroke patterns in diabetic and non-diabetic patients, focusing on the prevalence of ischemic and hemorrhagic strokes and associated vascular risk factors. Methodology: A comparative cross-sectional study was conducted on 60 patients aged 25 years and above who were equally divided into diabetic and non-diabetic groups based on documented medical history and standard diagnostic criteria. Stroke diagnosis was confirmed via neuroimaging with classification into ischemic or hemorrhagic subtypes. Results: The diabetic group had a mean age 55.03±10.09 years while non-diabetics averaged 56.77±11.02 years. BMI was notably higher in diabetics 29.43±2.35 kg/m² vs. 25.82±2.13 kg/m². Hypertension and dyslipidemia were more frequent in diabetics at 46.7% and 36.7% respectively compared to 20.0% and 13.3% in non-diabetics. A history of cardiovascular disease was significantly higher in diabetics, 26.7% vs. 6.7%. Ischemic strokes were more frequent among diabetics, 83.3%, compared to non-diabetics, 56.7%. Conclusion: Diabetes considerably influences stroke patterns with a higher prevalence of ischemic strokes and associated vascular risk factors.

Assessment of Frequency and Contributing Risk Factors Associated with the Development of Mammary Fistula After Incision and Drainage in Cases of Breast Abscess: A Single-Center Experience

Zarka Ahmad — 2025-02-28

A breast abscess is a localised collection of pus within the breast parenchyma, typically developing under the skin. In most cases, it occurs as a result of a bacterial infection. Management includes oral and IV antibiotics, percutaneous needle aspiration, ultrasound-guided aspiration, and incision and drainage. U/S guided aspiration is currently the standard treatment. A mammary fistula is a complication of breast surgery or other therapeutic interventions. A Mammary Fistula is defined as an abnormal communication between the lactiferous duct and breast skin. Treatment options include fistulectomy, primary closure and total duct excision. Postoperative wound infection is a primary factor in fistula recurrence. Objective: This study aims to determine the frequency of mammary fistula following incision and drainage in patients with breast abscesses. And also characterise the associated risk factors. Methods: A retrospective chart analysis was conducted at Khyber Medical Centre, Peshawar, Pakistan, from March 2023 to November 2023. Patients presenting with breast abscesses, irrespective of type, confirmed on clinical examination and radiologic findings, were included in the study. Abscesses in patients with breast cancer or suspicious of malignancy, and post-oncological surgical procedures, were a part of the exclusion criteria. Data was collected from patients’ records using a self-administered data collection tool. The data were analysed using SPSS version 26.Results: The Mean age of the population was 27.8 years, with an average range between 20 and 37 years. Among the types of breast abscesses, lactational abscesses were the most common, affecting 35 (85.4%) patients. The peri-areolar incision group had a milk fistula in 7 out of 9 patients. Only two cases were reported with radial incisions. All patients with fistula had a stab incision and drainage (100%), while no case was reported in patients with incision drainage with penrose drain insertion. Conclusion: Mammary Fistula is not a common complication of therapeutic incision and drainage. It primarily affects young lactating women and is a sequel to breast abscess. The location of the abscess and the incision site are contributing factors. Peripherally placed incisions are safer than central incisions.

Anatomical and Functional Outcome of Suprachoroidal Triamcinolone Injection in Patients of Refractive Diabetic Macular Oedema

Madiha Arshad — 2025-02-28

The most frequent cause of central vision loss in people with diabetes with diabetic retinopathy is diabetic macular edema (DME). Recently, there has been a greater interest in investigating the suprachoroidal space for medication administration to lessen the adverse effects of intravitreal steroids. Objective: "To determine mean change in macular thickness and best corrected visual acuity after suprachoroidal triamcinolone injection in patients of refractive diabetic macular oedema. Quasi-experimental study. Department of Ophthalmology, DHQ Hospital, Sahiwal, from 07-12-2021 to 07-06-2022. Methodology: Sixty eyes fulfilling selection criteria were enrolled and received an injection of triamcinolone acetonide. All patients were dilated before injection, and an indirect ophthalmoscope was placed in their hands to examine the fundus after injection. At baseline and after one month, the central macular thickened, BCVA was measured, and the change was calculated. Results: The mean age was calculated as 59.06 ± 6.02 years. Duration of diabetes was 5.36 ± 1.94 years and duration of symptoms 18.15 ± 6.57 days. Baseline BCVA was 0.28 ± 0.02, and post-treatment BCVA was 0.67 ± 0.11. Baseline central macular thickness was 469.31 ± 24.12, and post-treatment central macular thickness was 292.48 ± 8.38. The distribution of change in BCVA was 0.39 ± 0.09, and central macular thickness was 176.83 ± 15.74 (p=0.000). Our study had 75.0 %( n=45) males and 25.0% (n=15) females. Distribution of lateral side was done, 66.7 %( n=40) had left side affected and 33.3 %( n=20) had right side. Conclusion: Thus, suprachoroidal triamcinolone injection may help improve macular thickness and BCVA in patients with refractive diabetic macular oedema.

A Comparative Study of Ripasa Score and Alvarado Score in Diagnosis of Acute Appendicitis

Jan Muhammad — 2025-02-28

Among the most frequent causes of right iliac fossa pain is acute appendicitis. Developed to lower the likelihood of negative appendectomy are several scoring systems for diagnosing acute appendicitis. Objective: This study was motivated by a comparison of the RIPSA score with the Alvarado score based on histology reports for the diagnosis of acute appendicitis. Methods: Between November 2023 and June 2024, the emergency general surgery department at Lady Reading Hospital, Peshawar, conducted a prospective cross-sectional study. Based on histopathology data, both scoring methods were applied to the same patient and assessed for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. Alvarado achieved a score of 7.5, which coincided with RIPASA's cut-off value of 7.5.Results: The study included a total of 194 patients. With values of 97.42% and 86.08%, respectively, the RIPASA score demonstrates a higher diagnostic accuracy than the Alvarado score. For RIPASA, sensitivity, specificity, PPV, and NPV came at 98.86%, 84.21%, 98.3%, and 88.89%, respectively. By contrast, Alvarado had sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 96.89%, 33.33%, 87.64%, and 68.75%, respectively. Conclusion: Then the RIPASA scoring system shows better sensitivity, specificity, and diagnostic accuracy than the Alvarado scoring system.

Pre-Operative Serum Albumin As A Predictor of Abdominal Wound Related Complications in Patients Undergoing Emergency Exploratory Laparotomy

Sharmeen Nadeem Jokhio — 2025-02-28

Hypoalbuminemia is recognized as a key indicator of poor surgical outcomes, particularly in emergency settings. In patients undergoing emergency exploratory laparotomy, preoperative serum albumin levels may serve as a predictive marker for postoperative wound-related complications such as surgical site infections (SSI) and wound dehiscence. Early identification of at-risk patients can help guide perioperative nutritional and wound management strategies. Objective: This study aims to evaluate the predictive value of preoperative serum albumin levels for postoperative wound-related complications in patients undergoing emergency exploratory laparotomy, including surgical site infections and wound dehiscence. Methods: After the ethical approval from the institutional review board, this prospective observational study was conducted at the Department of General Surgery in Dr Ruth KM PFAO Civil Hospital Karachi, from 1st October 2024 to 30th December 2024.Through non probability consecutive sampling, 100 patients aged 18-75 years, both gender, undergoing Emergency exploratory laparotomy, and whose preoperative serum albumin screen results become available within 24 hours preceding their operation Results: The comparison of serum albumin levels between patients with and without postoperative wound infections and wound dehiscence revealed significant findings. Patients with serum albumin levels below 3.5 g/dL had a higher occurrence of wound infections (12 vs. 32 patients, p = 0.107), though the association was not statistically significant. However, for wound dehiscence, the relationship with serum albumin was highly significant (p = 0.001), as 12 patients with albumin levels below 3.5 g/dL developed wound dehiscence compared to only two patients with levels above 3.5 g/dL. Additionally, the presence of comorbidities did not show a statistically significant association with postoperative wound infection (p = 0.509). Conclusion: Patients with low preoperative serum albumin levels face higher risks of developing postoperative wound problems which mainly include surgical site infections and wound dehiscence.

Low Back Pain And Work –Related Factors Among Nurses In Intensive Care Units

Areeba Yaqoob Khan — 2025-02-28

Low back pain (LBP) is a common occupational health concern among nurses, particularly those working in intensive care units (ICUs), due to the physical demands and shift patterns associated with patient care. Objective: To assess the prevalence and identify risk factors associated with low back pain among ICU nurses at a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted from January 2024 to January 2025 at the Intensive Care Unit of Chaudhary Pervaiz Elahi Institute of Cardiology, Multan. A total of 100 ICU nurses directly involved in patient care were included. LBP prevalence was assessed based on self-reported pain frequency over the last 12 months using a four-point Likert scale: always, once weekly, once monthly, once bimonthly, or several months. Nurses also reported whether they had sought medical treatment for LBP. Odds ratios (OR) were calculated to determine the risk associated with clinical specialities, night shift frequency, and perception of staffing adequacy. Results:88% of ICU nurses reported experiencing low back pain in the past year. Pain was reported as occurring once a week by 40%, once a month by 28%, and always by 20% of participants. Only 20% of nurses had sought medical consultation for their symptoms. Nurses working in general surgical ICUs had a significantly elevated risk of LBP (OR: 1.71, 95% CI: 0.98–2.83, p=0.049), while those in cardiology and neurology ICUs were at the highest risk (OR: 3.01, 95% CI: 1.26–5.49, p=0.009). Additionally, working ≥6 night shifts per month increased LBP risk by 50%, and nurses perceiving inadequate staffing had a 65% higher risk of LBP. Conclusion: There is a high prevalence of low back pain among ICU nurses, with significant associations with clinical speciality, night shift frequency, and perceived staffing levels. Targeted interventions, including ergonomic training, workload redistribution, and optimised staffing, are needed to mitigate the burden of LBP in ICU settings.

Phototherapy-Induced Hypocalcemia in Icteric Term Neonates

. Naghmana — 2025-02-28

Neonatal jaundice requiring phototherapy is a common condition, but phototherapy has been associated with potential side effects, including hypocalcemia. Understanding the frequency and risk factors of phototherapy-induced hypocalcemia can aid in its prevention and management. Objective: This study aimed to determine the frequency of phototherapy-induced hypocalcemia in icteric term neonates and assess its association with demographic and clinical factors. Methods: A prospective cross-sectional study was conducted in the emergency department of a tertiary care hospital. After obtaining ethical board approval and informed parental consent, 150 term neonates with hyperbilirubinemia requiring phototherapy were enrolled from 26 July 2024 to 26th January 2025. Demographic data, including age, gender, birth weight, gestational age, and bilirubin levels at presentation, were recorded. Blood samples were collected before and after 48 hours of phototherapy to assess serum calcium levels. Hypocalcemia was defined as a serum calcium level <8.4 mg/dL. Data were analysed using SPSS version 25, with statistical significance set at p ≤ 0.05. Results: The mean age of neonates was 2.41 ± 0.80 days, with a birth weight of 3.08 ± 0.80 kg and a gestational age of 37.77 ± 1.25 weeks. The mean bilirubin level at presentation was 22.62 ± 1.34 mg/dL, and the average duration of phototherapy was 31.97 ± 9.26 hours. Of the enrolled neonates, 54.7% were male, and 45.3% were female. Phototherapy-induced hypocalcemia occurred in 26.7% of cases. Stratification by age showed hypocalcemia rates of 17.5% in 1-day-old, 12.5% in 2-day-old, and 70% in 3-day-old neonates, though the differences were not statistically significant. Hypocalcemia was more frequent in neonates with bilirubin levels >21 mg/dL and those requiring prolonged phototherapy, though these findings also lacked statistical significance. Conclusion: Phototherapy-induced hypocalcemia is a notable concern in neonates undergoing treatment for hyperbilirubinemia. While no statistically significant associations were observed with age, gender, or gestational age, neonates with higher bilirubin levels and prolonged phototherapy appear to be at greater risk. Close monitoring of calcium levels in these neonates is recommended to prevent complications and improve patient outcomes.

Incidence of Hepatocellular Carcinoma in Patients With Chronic Hepatitis C Genotype III and Advanced Hepatic Fibrosis After Treatment With DAA

Hamna Waqar — 2025-02-28

Direct-acting antivirals with high efficacy and safety are effective in the treatment of cirrhotic and fibrosis patients with chronic hepatitis C patients. Objective: We conducted this study to assess the incidence of hepatocellular carcinoma in chronic hepatitis C patients genotype III with hepatic fibrosis or cirrhosis after the achievement of sustained viral response after treatment with direct-acting antivirals. Methods: A prospective study was conducted at the Department of Medicine, Arif Memorial Hospital, Lahore, from October 2023 to October 2024. A total of 500 CHC genotype III patients diagnosed with F3 and F4, who were undergoing treatment with direct-acting antivirals, were included in the study. Patients received a 3-month or 6-month course of DAA regimens. HCC was diagnosed by performing triphasic MSCT, and staging was done. Results: Out of 500 patients, 50 patients were diagnosed with HCC in the follow-up. HCC patients were predominantly elderly and male and had elevated AST, AFP, and bilirubin levels, as well as reduced platelet and albumin levels, compared to non-HCC patients. In cirrhotic patients, the HCC incidence per year was 2.920 per 100 people. Advanced age, male gender, increased AFP, and decreased albumin were among the predictors of HCC incidence in F4 patients. Conclusion: A reduced incidence of HCC was observed in patients with CHC fibrosis and cirrhosis who achieved SVR after treatment with DAAs.

Lidocaine in Decreasing the Perioperative Opioid Analgesic Requirements After Ambulatory Surgery

Hanesh Tanwani — 2025-02-28

Infusions of lidocaine at low doses have an excellent safety record. It has been proposed that intravenous lidocaine infusion improved overall surgical outcomes and reduced postoperative discomfort. Objective: To compare the mean opioid analgesic requirements in patients undergoing ambulatory surgery receiving lidocaine versus placebo. Methods: This randomized control trial was conducted from January 2024 to June 2024 at the Anaesthesia Department of Liaquat National Hospital. A total of 80 patients were included and divided equally into the 1.5 mg/kg lidocaine group and the Placebo group. A visual analog scale (VAS) was used to measure pain while at rest. At the time of discharge from the anesthesia care unit (PACU), 2 hours and 4 hours in a hospital stay. The data was compiled and analyzed using SPSS. Results: The placebo group consisted of 45% males, while the lidocaine group comprised 50% male patients. The mean VAS in PACU at 2 and 4 hours for the lidocaine group was 1.50±2.01 and 1.70±1.69 respectively, while the mean VAS for the placebo group was 1.75±1.94 and 3.52±3.04. Overall, 20% of patients in the lidocaine group required nalbuphine, compared to 50% of placebo. The study groups and the need for nalbuphine were significantly associated (p = 0.005). There was a significant mean difference in nalbuphine dose by study group for patients whose surgeries lasted longer than 60 minutes (p = 0.038). Conclusion: Lidocaine infusion reduces the incidence of PONV, the total need for opioids, and the severity of postoperative pain.

Complications of Pediatric Tonsillectomies at Divisional Headquarter Teaching Hospital Kohat: Descriptive Case Series Study

Muhammad Aimen Ikram — 2025-02-28

Tonsillectomy is a commonly performed surgical procedure in pediatric patients for recurrent tonsillitis and obstructive sleep apnea. Despite its effectiveness, postoperative complications can impact recovery and patient outcomes. Identifying the frequency and nature of these complications can aid in optimising perioperative management and reducing morbidity. Objective: This study aimed to determine the frequency of complications following pediatric tonsillectomy. Methodology: A descriptive case series was conducted at the Department of ENT, Divisional Headquarter Teaching Hospital Kohat. One hundred thirty-one pediatric patients aged 1 to 12 years who underwent tonsillectomy were included through non-probability consecutive sampling. Patients with hematological disorders, congenital anomalies, or those undergoing adenotonsillectomy were excluded. Ethical approval was obtained, and informed consent was secured from guardians. Tonsillectomy was performed using extracapsular dissection and bipolar electrocautery techniques, with postoperative follow-up on the 1st, 7th, and 15th days. Complications, including hemorrhage, respiratory distress, infection, pain, and nausea, were recorded. Results: The mean age was 6.15 ± 3.63 years, with 54.2% males. Hemorrhage occurred in 3.8% of cases. Respiratory complications affected 7.6% of children. Infection was seen in 9.2% of children. Pain was recorded in 4.6% of children. Nausea was the most frequent complication, occurring in 14.5% of children. Conclusion: Post-tonsillectomy complications vary with age. Hemorrhage (3.8%) is more frequent in older children, while respiratory complications (7.6%) affect younger ones. Infection (9.2%) is linked to shorter symptom duration, pain (4.6%) is more common in females, and nausea (14.5%) is the most frequent complication. These findings emphasise the need for enhanced postoperative monitoring and individualised management strategies to reduce morbidity.

Intraoperative Partial Pressure of Oxygen Measurement to Predict Flap Survival

Muhammad Raza Tahir — 2025-02-28

Flap survival is a critical factor in reconstructive surgery, with ischemia-related complications leading to necrosis and surgical failure.
Current methods for intraoperative flap assessment are often subjective, creating a need for an objective, real-time measure of tissue viability. The
partial pressure of oxygen (pO₂) may serve as a reliable predictor of flap survival, allowing for early intervention and improved surgical outcomes.
Objective: Our study set out to explore whether the intraoperative measurement of the partial pressure of oxygen (pO₂) could reliably predict flap
survival in reconstructive surgery, aiming to pinpoint a practical tool for surgeons to assess tissue viability during operations. Methods: We enrolled
70 patients, all aged 18 years and above, who were undergoing flap procedures at our institution. Flap types varied across pedicled, free,
fasciocutaneous, and musculocutaneous designs. Intraoperatively, we maintained a consistent fraction of inspired oxygen at 50% and, at 30 minutes
post-flap inset, collected capillary blood samples from proximal, middle, and distal flap regions, alongside a fingertip control, using heparinised
syringes. These samples were analysed with a blood gas machine to determine pO₂ and diff-pO₂ values, while flap survival was later judged clinically
by tissue health, with complications like thrombosis or hematoma noted during surgery. Results: The mean flap pO₂ stood at 105.34 mmHg (±21.479),
finger pO₂ at 149.20±16.909 mmHg, and diff-pO₂ at 75.81±26.417 mmHg. Survival reached 82.9%, while complications were sparse, showing
thrombosis in 7.1% and hematoma in 4.3%. Pedicled flaps, making up 57.1% of cases, appeared most prone to necrosis. Conclusion: We conclude
that this approach could guide timely interventions, though further refinement of pO₂ cutoffs and risk factors is needed to sharpen its clinical impact.

Role of Multistrain Probiotics in Presentation of Severity and Frequency of Upper Respiratory Tract Infection

Dua Akhtiar — 2025-02-28

Upper respiratory tract infections (URTIs) are a common health issue that significantly impact individuals’ quality of life. Probiotic supplementation has been suggested as a potential intervention to reduce URTIs’ frequency, severity, and duration. Objective: This study aimed to evaluate the role of multistrain probiotics in the presentation of severity and frequency of URTIs. Methods: This cross-sectional study was conducted at Abbasi Shaheed Hospital, Karachi, during July 2024 to December 2024. The study involved a total of 185 patients, aged between 4 and 12 years. Data collection was carried out in two phases: baseline and follow-up. At baseline, participants underwent a thorough medical examination and completed questionnaires assessing their general health and history of respiratory infections. Results: The treatment group experienced a significantly lower frequency of URTIs (1.14 episodes per participant) compared to the other group (2.03 episodes per participant, p < 0.01). Symptom severity, as indicated by the Jackson score, was significantly reduced in the probiotic group (2.3 ± 0.8) compared to the other group (3.4 ± 1.1, p < 0.05). The duration of illness was also shorter in the treatment group (4.5 ± 1.2 days) compared to the other group (6.2 ± 1.5 days, p < 0.01). Immune markers showed a favorable response in the probiotic group, with reduced IL-6 levels and increased IL-10. Conclusions: Multistrain probiotics significantly reduce the frequency, severity, and duration of URTIs. The probiotics also positively impact immune function and quality of life, with minimal side effects. These findings suggest that multistrain probiotics could be a helpful adjunct in preventing and reducing the severity of URTIs, particularly in individuals prone to recurrent infections.

Analysis of Beliefs and Confidence Regarding Osteoporosis Among Nurses Working in Orthopedic Department

Shakeela Bano — 2025-02-28

Osteoporosis is a major global health concern, particularly in ageing populations. Nurses play a pivotal role in patient education and preventive care, making their health beliefs and self-efficacy regarding osteoporosis crucial in promoting effective prevention strategies. Understanding orthopaedic nurses' perceptions and confidence in managing osteoporosis can inform targeted educational interventions to enhance patient care. Methods: A cross-sectional analysis of 100 nurses working in the Orthopedic Department of Nishtar Hospital, Multan was conducted from January 2024 to January 2025. Inclusion criteria were registered nurses working full-time in the department. All participants were presented a self-reported questionnaire divided into three sections; sociodemographic data, Osteoporosis Health Belief Scale, and Self-efficacy. Results: The overall health beliefs score was 123.5 ± 13.66 with a moderately high score for advantage of exercise (20.53 ± 4.33) and health motivation (21.25 ± 4.11). While the susceptibility score (17.08 ± 5.28), seriousness for osteoporosis (16.70 ± 4.1), barriers to exercise (14.98 ± 3.75), and calcium intake (13.18 ± 3.93) had moderately low scores. Participants had a neutral score for the advantages of calcium intake (19.87 ± 3.7). The overall self-efficacy score was 71.97 ± 24.44 which was a moderately high score. The score for exercise was 31.48 ± 12.56 and for calcium consumption, it was 40.49 ± 11.88. Conclusion: The orthopaedic nurses had a moderately high self-efficacy and satisfactory health beliefs which highlight the importance and need for educational programs to educate nurses.

Frequency of Hyperuricemia in Patients with Psoriasis

Muhammad Zahid Hussain — 2025-02-28

Psoriasis is a chronic inflammatory skin disorder associated with systemic comorbidities, including metabolic syndrome and cardiovascular diseases. Hyperuricemia, characterized by elevated serum uric acid levels, has been implicated in systemic inflammation and metabolic dysfunction. However, its prevalence and association with psoriasis remain underexplored. Objective: To determine the frequency of hyperuricemia in patients with psoriasis. Methodology: A descriptive cross-sectional study was conducted at Khyber Teaching Hospital, Peshawar for six months from 22 June 2022 to 22 December 2022. One hundred twenty-one psoriasis patients, aged 12 to 70 years, were selected through a consecutive non-probability sampling method. Individuals with pulmonary disorders, chronic kidney disease, or those receiving medications that reduce uric acid levels were excluded from the study. The frequency of hyperuricemia was assessed in all patients. Results: The study found that 21.5% of psoriasis patients had hyperuricemia. The mean age of participants was 40.31 ± 12.82 years, and the mean disease duration was 5.82 ± 2.59 years. There was a significant association between disease duration and hyperuricemia (p = 0.044). However, no significant correlations were found between hyperuricemia and age, gender, or BMI (p > 0.05). Conclusion: The study concluded that hyperuricemia is prevalent among psoriasis patients, particularly those with a longer disease duration. Routine screening for hyperuricemia in psoriatic patients is recommended to prevent associated comorbidities, such as cardiovascular disease and metabolic syndrome.

Comparison Between Macrolides and Third-Generation Cephalosporin Preterm Pre-Labor Rupture of Membranes

Zahra Amir — 2025-02-28

Preterm Pre-Labor Rupture of Membranes (PPROM) has historically been treated with antibiotics. Objective: The study aimed to compare the effectiveness of macrolides (erythromycin) and third-generation cephalosporins (ceftriaxone) in managing Preterm Pre-Labor Rupture of Membranes (PROM). Methodology: A total of 240 pregnant women with preterm premature rupture of membranes (PPROM) occurring between 30–36 weeks of gestation were included in the randomized controlled trial and were assigned into two groups. Group A was given erythromycin (250 mg four times a day for 10 days), while Group B was given ceftriaxone (1g intravenously twice daily for 72 hours). Outcomes included the relative incidence of intrauterine infection, neonatal sepsis, and necrotizing enterocolitis (NEC). Results: The study found a high prevalence of preterm births among women, with 48.8% having PPROM and 32.5% exhibiting chorioamnionitis symptoms. Results demonstrated that Ceftriaxone was associated with better neonatal survival and lower infection rates than Erythromycin (p=0.01). Conclusion: The study concluded that third-generation cephalosporins are more effective in preventing neonatal sepsis and intrauterine infection in those suffering from PPROM. Further large-scale studies are advised to confirm these findings and to adjust antibiotic guidelines.

Comparative Study of Laparoscopic vs Open Surgery for Duodenal Ulcer Perforation

Usama fazal — 2025-02-28

Perforated duodenal ulcers are a typical surgical emergency. While open surgery has long been the standard treatment, laparoscopic techniques are gaining popularity due to their minimally invasive nature and potential for improved postoperative outcomes. Objective: To compare the outcomes of laparoscopic versus open surgery in the management of perforated duodenal ulcers. Methods: This randomised comparative study included 64 patients diagnosed with perforated duodenal ulcers. Patients were randomly assigned into two groups: Group A (n = 32) underwent laparoscopic surgery, and Group B (n = 32) underwent open surgery. Postoperative outcomes were evaluated, including operative time, duration of hospital stay, time to resume normal activities, and postoperative complications. Statistical analysis was performed using standard methods, with significance set at p ≤ 0.05. Results: Laparoscopic surgery was associated with a significantly longer operative time compared to open surgery (102.38 ± 22.62 minutes vs. 66.53 ± 11.49 minutes, p < 0.001). However, patients in the laparoscopic group experienced a significantly shorter hospital stay (8.47 ± 1.11 days vs. 10.03 ± 2.67 days, p = 0.005) and returned to normal activities sooner (15.09 ± 3.14 days vs. 19.44 ± 3.10 days, p < 0.001). Additionally, the laparoscopic group reported fewer postoperative complications compared to the open surgery group. Conclusion: Laparoscopic surgery, despite a longer operative time, demonstrates superior postoperative outcomes in the management of perforated duodenal ulcers, including reduced hospital stay, fewer complications, and faster recovery. It may be considered a preferable alternative to open surgery in suitable patients.

Comparative Study on the Effect of Zinc and Probiotic Therapy Versus Zinc Supplementation Alone on the Duration of Acute Watery Diarrhea in Children

Maryam Mateen — 2025-02-28

Diarrhea remains a leading cause of morbidity and mortality among children worldwide. Numerous studies have investigated the effects of zinc and probiotics in reducing the duration and severity of acute watery diarrhea. Objective: This study aimed to compare the efficacy of zinc-probiotic combination therapy with zinc-only therapy in managing acute watery diarrhea in pediatric patients. Methodology: Conducted at the Department of Pediatrics, Sughra Shafi Medical Complex, Narowal, from March 10, 2023, to August 10, 2024, the study enrolled 80 children diagnosed with acute watery diarrhea, who were randomly assigned into two groups. Group A received oral zinc, low osmolarity ORS, and continued nutritious feeding, while Group B was given Enflor sachets in addition to zinc and ORS. The duration of diarrhea was recorded, and data analysis was performed using SPSS v25.0. A t-test was used to compare the duration of diarrhea between the two groups, with statistical significance set at p ≤ 0.05. Results: The average age in Group A was 38.3±10.5 months, and in Group B, it was 38.6±10.1 months. The duration of diarrhea in Group A was 31.35±2.338 hours, compared to 24.08±2.495 hours in Group B, with a significant difference (p = 0.0001). Conclusion: The combination of probiotics and zinc was more effective than zinc alone in reducing the duration of acute diarrhea in children, suggesting a significant improvement in treatment outcomes.

Effect of Gum Chewing for Early Restoration of Bowel Activity After Cesarean Section

Anum Dilshad — 2025-02-28

Postoperative ileus is a common concern following cesarean section, leading to delayed gastrointestinal recovery. Chewing gum has emerged as a simple and non-invasive intervention to enhance bowel motility through the cephalic vagal reflex and stimulation of gastrointestinal hormone secretion, thereby promoting the early return of bowel sounds and passage of flatus. Objective: This study aimed to compare the mean postoperative time interval for the return of bowel sounds and the first passage of flatus between women who chewed gum and those who did not following a cesarean section. Methods: A prospective, randomised controlled trial was conducted at the Department of Obstetrics and Gynecology, Bahawalpur Victoria Hospital, Bahawalpur, over six months after ethical approval from October 2020 to March 2021. A total of 60 women aged 18 to 40 years undergoing elective cesarean section were included. Patients with electrolyte imbalances, diabetes, or prior intra-abdominal surgery were excluded. Participants were randomly allocated into two groups: Group A (gum chewing) and Group B (non-gum chewing). Women in Group A received one stick (5 grams) of chewing gum three times a day for one hour, starting six hours postoperatively. In contrast, Group B received standard postoperative care without gum chewing. The primary outcomes were the mean time to the first auscultation of normal bowel sounds and the first passage of flatus. Results: The mean age of patients in Group A was 30.20 ± 4.24 years, and in Group B, it was 29.87 ± 4.28 years. The mean time to the return of bowel sounds in Group A was significantly shorter (10.60 ± 1.90 hours) compared to Group B (16.03 ± 2.63 hours) (p < 0.0001). Similarly, the mean time to the first passage of flatus was significantly reduced in Group A (18.67 ± 2.38 hours) compared to Group B (25.63 ± 2.89 hours) (p < 0.0001). Conclusion: Chewing gum significantly reduces the time to the return of bowel sounds and the first passage of flatus following cesarean section, suggesting its effectiveness as a simple and safe intervention to enhance postoperative gastrointestinal recovery.

Pre and Post-Operative Lactate Levels and Lactate Clearance in Predicting in Hospital Mortality After Surgery for Gastrointestinal Perforation

Sharmeen Nadeem Jokhio — 2025-02-28

Gastrointestinal perforation is a life-threatening surgical emergency associated with significant morbidity and mortality. Early risk stratification is essential for optimizing perioperative management and improving outcomes. Lactate levels are a biomarker of tissue hypoxia and perfusion, and their clearance postoperatively may help predict in-hospital mortality. Objective: The objective of this study is to evaluate the prognostic significance of preoperative and postoperative lactate levels and lactate clearance in predicting in-hospital mortality following surgery for gastrointestinal perforation Methods: After the ethical approval from the institutional review board, this retrospective observational study was conducted at Department of general surgery in Dr Ruth KM PFAO civil hospital Karachi, from 1st October 2024 to 30th December 2024.Through non-probability consecutive sampling, 100 patients aged 18 and above, both genders, undergoing emergency surgery for gastrointestinal perforation, and availability of preoperative and postoperative lactate measurements. Results: Survivors had a significantly lower preoperative lactate level (3.17 ± 1.7 mmol/L) compared to non-survivors (6.7 ± 1.9 mmol/L), p < 0.0001. Similarly, postoperative lactate levels were markedly lower in survivors (2.6 ± 0.8 mmol/L) than in non-survivors (6.8 ± 2.3 mmol/L), also with a p-value < 0.0001. The area under the curve (AUC) for preoperative lactate was 0.905 (95% CI: 0.843–0.967, p < 0.0001), while postoperative lactate had an AUC of 1.0 (95% CI: 1.0–1.0, p < 0.0001), indicating perfect predictive ability. Conclusion: Hospital mortality rates of patients undergoing gastrointestinal perforation surgeries can best be predicted through lactate assessments performed before and after surgery.

The Role of Biomarkers in the Diagnosis and Prognosis of Ovarian Cancer: A Comprehensive Review

Shazia Sohail Tariq — 2025-02-28

Ovarian cancer remains one of the most lethal gynecologic malignancies owing to its often-asymptomatic nature and late-stage diagnosis. Biomarkers have emerged as critical tools in early detection, risk stratification, and prognostication. This review provides an in-depth analysis of the current landscape of biomarkers in ovarian cancer, addressing both diagnostic and prognostic roles. We explore classical biomarkers such as CA125 and HE4 and novel biomarkers including circulating tumor cells, microRNAs, and genomic signatures. In addition, we discuss advances in multi-marker panels and liquid biopsy approaches, underscoring the importance of integrating biomarker data with clinical parameters to guide personalized management. Limitations, challenges, and future perspectives are discussed, emphasizing the need for further validation in large, prospective trials. This comprehensive review integrates over 30 recent references to offer clinicians and researchers a robust resource for understanding and applying biomarker data in ovarian cancer management.