Biological and Clinical Sciences Research Journal

COMPARISON OF EFFECTIVENESS OF TOPICAL NIFEDIPINE AND DILTIAZEM IN THE TREATMENT OF ANAL FISSURES

. SADIA, S NASEER , A FAROOQI , I ZULFIKAR , S SAEED , HH SHAH — Thu, 04 Apr 2024 00:00:00 +0000

Anal fissure, a tear in the anal canal below the dentate line, is commonly managed pharmacologically as the primary approach, with surgery considered secondary. Objective: To compare the efficacy of topical nifedipine and diltiazem in the prompt resolution of pain and bleeding associated with anal fissure management. Methods: A prospective cohort study was conducted at Dr. Ruth K. M. Pfau Civil Hospital, Karachi, from June 2023 to November 2023. One hundred patients with anal fissures were randomly allocated into two groups: Group N (Nifedipine) and Group D (Diltiazem). Topical medication was administered until healing occurred. The visual analogue scale (VAS) assessed the patient's progress in terms of bleeding and pain. Side effects were monitored. Statistical analysis included an independent t-test for comparing VAS scores and a post-stratification chi-square test for associations between bleeding, side effects, and other variables. Results: At baseline, mean pain scores were 8.30±0.90 in group D and 7.78±1.29 in group N. At the first follow-up, mean pain scores were 5.58±1.34 in group D and 4.56±1.48 in group N, with a significant difference (p<0.001). Bleeding did not significantly decrease at the first follow-up but decreased significantly at the subsequent follow-ups in both groups. Side effects did not differ significantly between groups. Conclusion: Topical nifedipine is more effective than diltiazem for managing anal fissures in terms of pain reduction. However, both medications showed comparable efficacy in reducing bleeding, with no significant difference in side effects observed.

CURRENT POLICY ON HEPATITIS B VACCINATION AMONG TERTIARY CARE HOSPITAL HEMODIALYSIS PATIENTS

RA KHAN , ZA KHAN , M SHAHZAD , A GHANI , L ALI — Wed, 03 Jan 2024 00:00:00 +0000

A study was conducted at the Miangul Abdul Haq Jahanzeb Kidney Hospital in Swat to evaluate the vaccination status for hepatitis B among hemodialysis patients with chronic renal disease. The focus of the study was to determine the effectiveness of the hepatitis B vaccine in generating anti-HBS antibodies in this specific patient population. The primary objective was to identify and assess the hepatitis B vaccination status in patients undergoing hemodialysis due to chronic renal disease. This study aimed to determine the presence of anti-HBS antibodies in the patient's blood after receiving three or four doses of the 20-microgram hepatitis B vaccine between January 2022 and January 2023. The study followed a cross-sectional. The participants included hemodialysis patients with chronic renal disease. The validation of hepatitis B vaccination status was based on the measurement of the anti-HBS antibody titer in the patients' blood. This measurement was taken after administering three or four doses of the 20-microgram hepatitis B vaccine. A cut-off anti-HBS antibody titer of ≥10 IU/L was used to determine the effectiveness of the vaccination. The study included a total of 55 registered patients in the age range of 25 to 65 years. The average age of the patients was 48.70 ± 5.245 years. Among the participants, there was a ratio of 1.6:1, with 28 (25.7%) patients receiving three doses of the hepatitis B vaccination and 81 (72.2%) patients receiving four doses. The results indicated that 40 patients (50.2%) had confirmed vaccinations, as evidenced by an anti-HBS antibody titer of ≥10 IU/L. Patients with chronic kidney disease had a lower chance of developing anti-HBS antibodies with ≥ ten IU/L after hepatitis immunization. Individuals who get vaccinations early in the disease have a higher chance of developing advanced immunity.

THE IMPACT OF LIP FORM ON THE PERCEPTION OF THE IDEAL INCISAL DISPLAY AT REST

MI MUNAWAR , M EJAZ , AZ YASEEN, SA SHAH — Tue, 13 Feb 2024 00:00:00 +0000

The perception of an aesthetically pleasing smile involves a multitude of factors, among which the shape and form of the lips play a pivotal role. Understanding how lip morphology influences the perception of an ideal incisal display during rest is crucial in the realm of cosmetic dentistry and facial aesthetics. The basic aim of the study is to find the impact of lip form on the perception of the ideal incisal display at rest. A total of 214 participants were enrolled in this observational study, meeting the inclusion criteria of being 18 years or older and representing diverse racial backgrounds. Exclusion criteria comprised individuals with oral health conditions impacting lip posture, recent dental procedures influencing incisal display, and cognitive impairments hindering compliance with instructions. Demographic information, including age, gender, and racial background, was recorded for each participant. Incisal display measurements were obtained and documented by trained evaluators following established procedures to minimize potential bias or variations in assessments. Thirty-six modified images simulating varied levels of maxillary incisal shown across three distinct lip forms—straight, moderate, and high—were created from the initial photographs of 214 volunteers. The mean incisal show for the linear lip form was hypothetically calculated as 1.5 mm (SD = 0.3), 2.3 mm (SD = 0.4) for the moderate lip form, and 3.0 mm (SD = 0.5) for the high lip form. Statistical comparison using ANOVA revealed significant differences in mean incisal display among lip form categories (F(2,105) = 80.72, p < 0.001). It is concluded that there is a strong association between lip form, cultural influences, and preferences for incisal display, highlighting the intricate role of individual perceptions in shaping dental aesthetic preferences. This inclination towards varied incisal displays appears to resonate across both dental professionals and laypersons, remaining consistent irrespective of gender.

DIAGNOSTIC ACCURACY OF TIRADS CLASSIFICATION IN DIFFERENTIATING BENIGN AND MALIGNANT THYROID NODULES KEEPING FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) AS GOLD STANDARD

HA SAQIB , U SAEED , M ZAHRA , A NOREEN , A FIRDOUS , ZU ISLAM — Mon, 11 Mar 2024 00:00:00 +0000

Thyroid nodules represent a joint clinical presentation of various benign and malignant thyroid diseases. Diagnostic ultrasound, particularly utilizing the Thyroid Imaging Reporting and Data System (TI-RADS), has emerged as a pivotal tool for stratifying the risk of malignancy in thyroid nodules and guiding decisions regarding fine-needle aspiration biopsy (FNAC). However, comprehensive validation studies are warranted to assess the diagnostic accuracy of ultrasound-based TI-RADS classification compared to FNAC as the gold standard. This cross-sectional validation study, conducted at the Department of Radiology, CPE Institute of Cardiology Multan from August 2, 2021, to February 1, 2022, enrolled 243 patients presenting with thyroid nodules, including multiple and solitary nodules. Baseline demographic variables, including age, gender, and nodule duration, were recorded for each participant. Ultrasonography was performed in all patients, and TI-RADS scores were calculated. Subsequently, fine-needle aspiration biopsies, guided by ultrasound, were obtained in the radiology department and sent to the histopathology department for confirmation of malignancy. The mean age of the cohort was 42.05 ± 12.27 years, with a mean nodule duration of 6.87 ± 3.56 months. The mean TI-RADS score was 3.46 ± 2.00. Of the participants, 176 (72.43%) were male and 67 (27.57%) were female. Malignancy was detected in 84 (34.57%) patients based on TI-RADS score, whereas FNAC confirmed malignancy in 50 (20.58%) patients. Evaluating diagnostic accuracy with FNAC as the gold standard, the TI-RADS score demonstrated a sensitivity of 84.0%, specificity of 78.2%, positive predictive value (PPV) of 50.0%, and negative predictive value (NPV) of 95.0%. Our findings indicate that the TI-RADS scoring system is reliable in predicting malignancy in patients with thyroid nodules. With a sensitivity of 84.0% and specificity of 78.2%, TI-RADS represents a valuable adjunctive tool in the diagnostic algorithm for thyroid nodules, offering considerable potential for improved clinical decision-making and patient management strategies.

COMPARISON OF POST-OPERATIVE OUTCOMES OF MASS CLOSURE CONTINUOUS TECHNIQUE VS HUGHES REPAIR IN PATIENTS UNDERGOING EXPLORATORY LAPAROTOMY

SS ULLAH , MURK HIRAJ , MF SHAH , M ZAKRIA , M SHAHID — Sat, 20 Apr 2024 00:00:00 +0000

Surgical techniques for abdominal closure following exploratory laparotomy play a crucial role in determining postoperative complications. The mass closure continuous approach and Hughes repair are commonly employed methods with unique characteristics and outcomes. Objective: This retrospective comparative study aimed to evaluate the incidence of postoperative complications associated with the mass closure continuous approach and Hughes repair in patients undergoing exploratory laparotomy. Methods: The study was conducted at Nishtar Hospital Multan from July 2023 to December 2023. A total of 50 patients aged between 18 and 60 years of both genders, undergoing exploratory laparotomy, were included through non-probability sampling. Patients were treated either with the mass closure continuous technique or Hughes repair for abdominal closure. The mean operative time for each technique was recorded. The incidence of postoperative complications, including incisional hernia, wound infection, abdominal burst, and seroma, was assessed. Statistical analysis was performed using appropriate methods. Results: The mean operative time for the mass closure continuous technique was 16.32±2.1 minutes, significantly lower than that of Hughes repair (p<0.0001). Patients treated with Hughes repair demonstrated a significantly lower incidence of incisional hernia, wound infection, abdominal burst, and seroma compared to those treated with the mass closure continuous technique. Conclusion: Hughes's repair technique for abdominal closure following exploratory laparotomy is associated with reduced occurrence of postoperative complications, including incisional hernia and wound-related issues. Therefore, it may be considered a safe and effective option for abdominal closure in these patients.

FREQUENCY OF HYPOGLYCEMIA IN NEWBORN WITH BIRTH ASPHYXIA

Z AHMAD , IU KHAN , A SHEHZAD — Fri, 26 Jan 2024 00:00:00 +0000

Birth asphyxia is a significant health concern in Pakistan, often leading to severe complications that contribute to long-term morbidity and mortality in neonates. Understanding the frequency and associated factors of hypoglycemia, a common complication in neonates with birth asphyxia, is crucial for improving neonatal care and outcomes. This study aimed to determine the frequency of hypoglycemia in neonates with birth asphyxia and to explore its association with residential and socioeconomic status. A cross-sectional study was conducted in Pediatric Unit C, MTI Lady Reading Hospital (LRH), Peshawar, from April 27th, 2019 to October 26th, 2019. The study received approval from the hospital's ethical committee. Using a non-probability sampling technique, 141 neonates, aged up to 72 hours and diagnosed with birth asphyxia, were enrolled. The frequency of hypoglycemia among these neonates was observed and recorded. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS), version 23. The study findings revealed a significant association between hypoglycemia and both residential and socioeconomic status in neonates with birth asphyxia. Notably, hypoglycemia was more prevalent in neonates from rural areas and those belonging to lower socioeconomic backgrounds. Hypoglycemia is a common complication in neonates with birth asphyxia, with a higher incidence observed in rural areas and among lower socioeconomic groups. These findings underscore the need for targeted interventions and enhanced neonatal care strategies, particularly in underserved communities, to mitigate the risks associated with birth asphyxia and its subsequent complications. This study contributes to the growing body of evidence on neonatal health in developing countries and highlights the critical need for addressing healthcare disparities in these settings.

GLYCOSYLATED HEMOGLOBIN HBA1C AS A BIOMARKER FOR DIABETIC RETINOPATHY

S FATIMA , S ASHRAF , A TAHIR , A BATOOL , I LATIF , I AMEEN — Tue, 27 Feb 2024 00:00:00 +0000

: Diabetes Mellitus (DM) is a long-term metabolic disorder marked by hyperglycemia. Diabetes may lead to various complications like retinopathy. Diabetic retinopathy is a microvascular disorder that may lead to vision loss. It was a hospital-based study to determine the prevalence of diabetic retinopathy in chronic diabetic patients. Patients who visited DHQ and Al Sheikh Hospital Sialkot with blurry or poor vision were taken as samples. The sample size for this study was 100. The demographic and medical history of patients were taken through a questionnaire. These patients were checked by an experienced ophthalmologist after the pupil dilation. After the proper examination, it was suggested that a patient have an HbA1c test to monitor diabetic control. The HbA1c test is one of the most effective techniques to monitor diabetic control. Out of the 100 patients, 60% were diagnosed with diabetic retinopathy. Out of these, 36% were diagnosed with non-proliferative diabetic retinopathy, and 24% were diagnosed with proliferative retinopathy. The results were quite alarming, as 60 out of 100 were suffering from diabetic retinopathy. This study provided the prevalence of diabetic retinopathy in the district of Sialkot. This study also helps to understand the severity of hyperglycemia that may lead to vision loss due to diabetic retinopathy.

ASSESSMENT OF THE THERAPEUTIC EFFICACY OF PROPRANOLOL FOR THE TREATMENT OF INFANTILE HEMANGIOMAS

MA SHABBIR , U KHAN , GR LATIF , S ZAHRA , UB BUTT — Thu, 28 Mar 2024 00:00:00 +0000

Infantile hemangiomas (IHs) are common vascular tumors affecting pediatric populations, often necessitating medical intervention due to their potential for complications. Propranolol has emerged as a promising therapeutic option for IHs, although optimal dosing regimens and treatment outcomes remain areas of ongoing research. This prospective observational study aimed to evaluate the therapeutic efficacy, safety profile, and clinical characteristics associated with propranolol treatment in pediatric patients with IHs. Eighty infants aged one month to 1 year were included in the study, with IH occurrence and treatment initiation predominantly observed within the first 12 months of life. Propranolol was administered orally at a starting dose of 2 mg/kg/day, titrated up to 3-4 mg/kg/day as tolerated. Assessment of therapeutic response revealed significant reductions in IH size and vascularity, with 31.3% of patients demonstrating an excellent response and 37.5% showing a good response. Adverse effects were minimal, with diarrhea (22.5%) and decreased heart rate (7.5%) being the most commonly reported side effects. Anatomical distribution analysis identified the parotid region as the most common site of lesion occurrence, highlighting the heterogeneous nature of IHs. Overall, our findings support the favorable outcomes of propranolol therapy in pediatric patients with IHs, emphasizing the need for individualized treatment approaches tailored to patient-specific characteristics.

PREVALENCE AND EFFECTS OF PROGRESSIVE OSTEOARTHRITIS ON SEX STEROIDS IN MALE AND FEMALE PATIENTS OF DISTRICT BUNER, KPK PAKISTAN

L KHAN, S SHAMAS, S TABASSUM, M ALAM, BT KHAN , IZ QURESHI — Sat, 13 Jan 2024 00:00:00 +0000

Osteoarthritis is a major cause of disability in older people; pain is considered one of the most important signs of osteoarthritis, which normally affects the weight-bearing joint, especially the knee joint. The objective of the present study was to find out the prevalence and effects of progressive Osteoarthritis (OA) on sex steroids in male patients of district Buner KP, Pakistan. Data was collected from 294 OA patients (Male, 46.18%; Female, 54.76%) at different hospitals through questionnaires, face-to-face interviews and blood sampling in district Buner. Results showed that the 50 to 60-year age group was mostly affected by OA (29.81%). In the case of females, OA was common in the plain areas, while male patients were in hilly areas. Among 294 patients, housewives (23.46%) and agriculture (18.7%) are more affected by Osteoarthritis. Blood samples were collected from 18 male patients of different age groups and analysed through the ELISA (enzyme-linked immunosorbent Assay) Test. The results obtained from ELISA showed that most of the OA patients have normal testosterone levels, but the two age groups, i.e., 50 to 60 and 60 to 70, have abnormal results of 0.251 ng/ml and 1.89 ng/ml. After analysis of all testosterone test results at different age groups, analysis of variance (ONE WAY ANOVA) results show that SS, MS and F values were 36.30, 7.26 and 9.3, respectively. We concluded that people over 40 are more likely to get OA. Osteoarthritis is more common in women than males, and it is more common in overweight people. Mountainous locations have a higher incidence of males with OA than females. Additionally, there are more females than males in plain terrain. According to our findings, bilateral OA is more typical than unilateral OA. Our research indicates a tenuous connection between OA and male patients' testosterone levels.

PREDICTORS AND OUTCOMES OF NEONATAL SEPSIS IN TERTIARY CARE SETTING: A RETROSPECTIVE STUDY

F ALI, H ADIL, U MANZOOR, N AZIZ, M IQBAL — Tue, 13 Feb 2024 00:00:00 +0000

Neonatal sepsis represents a critical challenge in healthcare, particularly in tertiary care settings. A comprehensive understanding of the predictors and consequences is pivotal for enhancing clinical practice and patient outcomes. A retrospective study was conducted on a sample size of 120 neonates to explore the predictors and outcomes of neonatal sepsis. The analysis encompassed a wide range of variables, including maternal characteristics (e.g., age, religion, education), obstetric factors (e.g., PROM, UTI/STI history), neonatal demographics (e.g., age, sex, birth weight), healthcare facilities (e.g., place of delivery, length of stay), and clinical care parameters (e.g., invasive procedures, mode of delivery). Multivariate logistic regression was employed to identify relationships between these factors and sepsis outcomes. Maternal and obstetric factors showed significant correlations with neonatal sepsis. Neonatal characteristics revealed a mean age of 3.1 days, equal gender distribution, and a mean birth weight of 2.6 kg. Health facility indicators pointed to balanced utilization and transport means. Clinical care variables illustrated a balance in delivery modes and attendance. The logistic regression model (Nagelkerke R²: 0.52) identified specific coefficients indicating relationships between variables and sepsis. The mortality rate among neonates with sepsis was 27.8%, with an average stay of 15 days and 38.9% complications rate. The study provides valuable insights into the multifaceted nature of neonatal sepsis, emphasizing the importance of maternal and clinical care factors. The results underscore the necessity for early identification, targeted interventions, and comprehensive care strategies to reduce the incidence and adverse outcomes of neonatal sepsis in tertiary care settings.

DETERMINATION OF ACCURACY OF 3-MILLIMETER THIN AXIAL SECTIONS OF 64-SLICE MULTI-DETECTOR COMPUTED TOMOGRAPHY SCAN IN DIAGNOSIS OF ACUTE APPENDICITIS

HA SAQIB , A NOREEN , U SAEED , M ZAHRA , ZU ISLAM , A FIRDOUS — Sun, 10 Mar 2024 00:00:00 +0000

Acute appendicitis is a common cause of acute abdominal pain requiring urgent surgical intervention. Timely diagnosis is crucial to prevent complications such as perforation and reduce morbidity and mortality rates. Clinical diagnosis alone can be challenging, leading to false positives and negatives. Multidetector computed tomography (MDCT) has emerged as a valuable tool in diagnosing appendicitis, but its efficacy can be enhanced by optimizing imaging protocols, particularly by utilizing thinner reconstruction sections. We conducted a prospective study involving 150 patients with suspected acute appendicitis. Un-enhanced 64-slice MDCT was performed, and axial images reconstructed from 3mm thin sections were analyzed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated using SPSS version 19. Our study demonstrated a sensitivity of 97.8% and specificity of 76.9% for diagnosing acute appendicitis using 3mm thin section MDCT. The NPV and PPV were 76.9% and 97.8%, respectively, with an overall accuracy of 96%. Utilizing 3mm thin axial reconstruction in 64-slice MDCT significantly enhances diagnostic accuracy for acute appendicitis. This approach holds promise in reducing negative appendectomies and associated morbidity and mortality rates. Implementation of this imaging protocol can aid in timely diagnosis, optimizing patient care, and reducing unnecessary hospitalizations. 64-slice MDCT with 3mm thin section reconstructed images emerges as a highly accurate technique for diagnosing or excluding appendicitis in patients with equivocal presentations, contributing to improved patient outcomes and healthcare resource utilization.

THE OUTCOME OF ANTIBIOTICS VS OPEN APPENDECTOMY FOR ACUTE NON-PERFORATED APPENDICITIS

RA RAJA , MH ABBASI , MRU TAJ , . TALHA, T QAYYUM — Wed, 10 Apr 2024 00:00:00 +0000

Acute appendicitis is a common surgical emergency. While appendectomy has been the conventional treatment for this condition, recent advancements in antibiotic therapy have led to exploring the use of antibiotics as a non-surgical alternative for treating non-complicated acute appendicitis. Objective: The objective of the present study was to compare the outcomes of administering antibiotics and performing emergency appendicectomy in a cohort of individuals diagnosed with non-perforated acute appendicitis based on CT evaluation. Methods: After the ethical approval from the institutional review board, this randomised control trial was conducted at Combined Military Hospital Jhelum from July 2022 to December 2023. The patients were randomly assigned, using a closed envelope method, to either have open appendectomy (Group A, n=60) or receive antibiotic therapy (Group B, n=60) with intravenous ertapenem. Open appendectomy was conducted utilising the McBurney technique. The patient’s outcomes were assessed during their hospitalization period, specifically on days 0, 1, and 2, and by telephone interviews one week and two months following the intervention. Pain scores were collected at two specific time points, one week and two months after randomisation, utilising a visual analogue scale (VAS). Results: No significant differences were observed in the baseline characteristics in both groups. Mean± S.D of the pain experience of the study participants in both groups was 4.16±1.04 and 3.68±1.02 (days) (P value=0.008). Mean± S.D of the hospital stay of the study participants in both groups was 3.13±0.87 and 3.16±0.83 (days) (P value=0.843). A significant difference in the VAS score was observed (p <0.0001) in the participants of both groups at discharge and after a one-week follow-up period. Conclusion: The findings of the study indicate that a significant proportion of individuals who received antibiotic therapy for non-perforated acute appendicitis did not necessitate the surgical procedure of appendectomy within the two-month post-treatment observation period.

FREQUENCY OF UTI IN PREGNANCY ASSOCIATED WITH PRETERM LABOUR: A CROSS-SECTIONAL STUDY

A SHAHZADI , F AHMAD — Sat, 27 Jan 2024 00:00:00 +0000

This Cross-Sectional Study aimed to determine how common urinary tract infections (UTIs) are in pregnant women experiencing preterm labour. In addition, the study assessed the standard procedure of routinely doing a urine culture and urinalysis simultaneously in these instances. The study was conducted between September 2022 and August 2023 at the Gynae & Obs Department of GKMC Swabi. The medical records of pregnant patients who were hospitalised at the Gynae & Obs department of GKMC Swabi due to preterm labour were analysed. The study determined the incidence of UTIs in these women. The women were divided into two groups based on their diagnoses upon admission: group 1 had preterm labour/preterm prelabour rupture of membranes (PTL/PPROM), and Group 2 had threatened preterm labour (TPL). Urinalysis and urine culture assessments were performed in these two groups to develop a plan to minimise unnecessary urine cultures. Out of 200 women who had preterm uterine contractions, 4.9% had a UTI. There was no difference in the prevalence of UTI between the two groups of women. 3.5% of the urine samples had a positive culture. Escherichia coli was the most commonly found bacterium in both groups of women. A urine culture with a positive screening rate of 7.2% and 91.2% sensitivity can be used to identify women in the TPL group who should have their urine cultured if an abnormal cell counts or a large presence of bacteria exists in the urine. This method can reduce unnecessary urine cultures. The study found that among pregnant women with preterm labour, the incidence of UTIs was 4.9%, with no statistically significant variation between subgroups. Using certain criteria allows unnecessary urine cultures to be reduced while UTIs in this group are promptly detected.

VARIATIONS IN SERUM CONCENTRATIONS OF Hs-CRP IN PERIODONTITIS AND HEALTHY SUBJECTS

A AFZAAL , M AFZAAL , D TAHA , AW GHAURI , ZS KHAN , . QURATULAIN — Tue, 20 Feb 2024 00:00:00 +0000

CRP is a plasma protein that measures the acute phase response to systemic inflammation and is one of the markers of choice in monitoring numerous chronic diseases. Patients with periodontitis have specific haematological variations, such as higher C-reactive protein (CRP) levels and elevated pro-inflammatory mediator levels. This study aims to quantify Hs-CRP levels in periodontally healthy and diseased subjects and evaluate the relationship between periodontitis and Hs-CRP levels. This Case-control study recruited 120 patients from two study groups—60 cases of chronic periodontitis (moderate to severe) and 60 controls. Periodontitis is assessed by three different index scores, namely: Community periodontal index score (CPI), Clinical attachment level (CAL) and periodontal probing depth (PPD). The Hs-CRP is measured due to its high sensitivity to assess systemic inflammation, making it more effective than conventional CRP tests. Our study results indicate that Hs-CRP levels increase subsequently with the severity of the periodontal disease. Moreover, Clinical attachment level (CAL) is the most significant indicator of Periodontitis that correlates with systemic inflammation in the body. Hence, concluding that periodontitis, being an oral condition, can have a massive impact on general systemic health, and elevated Hs-CRP levels, considered a biomarker of chronic systemic inflammation, can be a future risk to several fatal systemic diseases.

DRUG AND ALCOHOL USE IN ORTHOPAEDIC TRAUMA PATIENTS: A PROSPECTIVE STUDY

MU FAROOQUE , K ANWAR , S HUSSAIN , MR KIFAYATULLAH, A GHAFFAR , J AHMED — Wed, 20 Mar 2024 00:00:00 +0000

The objective of this study is to prospectively investigate the prevalence, patterns, and correlates of drug and alcohol use among orthopaedic trauma patients. After the ethical approval from the institutional review board, this cross-sectional study was conducted at Jinnah Postgraduate Medical Center from 01/09/23 to 29/02/24. Baseline data was collected upon admission and included demographic information (such as age and gender) and a comprehensive assessment of substance use history. Substance use was assessed using validated screening tools, including the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Abuse Screening Test (DAST), to capture patterns of alcohol and drug use, frequency, duration, and any previous treatment history for substance use disorders. In the present study, the prevalence of drug and alcohol use among the orthopedic traumatic participants was (40%). Among them, the majority (51%) were using alcohol, followed by marijuana use (25%), and then cocaine (11%). The means of hospital stay of participants in substance non-users and users (2.4±0.8 vs. 6.83±1.1; P<0.0001). Pre-injury alcohol and drug use appear to correlate with extended hospital stays among patients with traumatic orthopaedic injuries.

COMPARISON OF BLUNT ABDOMINAL TRAUMA SEVERITY SCORING (BATSS) AND CLINICAL ABDOMINAL SCORING SYSTEM (CASS) IN BLUNT ABDOMINAL TRAUMA FOR NEED OF SURGICAL INTERVENTION

. SADIA, OB KHALID , I ZULFIKAR , R ALI , MS HUSSAIN , R WASEEM — Tue, 19 Mar 2024 00:00:00 +0000

Blunt abdominal trauma can result in severe intra-abdominal injuries that may necessitate surgery. Scoring systems such as Clinical Assessment Score for Suspected Abdominal Injury (CASS) and Blunt Abdominal Trauma in Severe Spleen Score (BATSS) aid in predicting the need for surgery but require further evaluation. Objective: To assess the efficacy of the CASS and BATSS scoring systems in predicting the necessity of surgical intervention for patients with blunt abdominal trauma. Methods: This comparative study was conducted at Dr. Ruth K. M. Pfau Civil Hospital Karachi from July 1, 2023, to December 31, 2023. Vital signs on admission, signs of abdominal tenderness, distension, guarding, and organ-specific symptoms were recorded for all participants. Diagnostic imaging findings from studies such as abdominal ultrasound, computed tomography (CT) scans, or X-rays were also collected. The study included a total of 185 participants. Statistical analysis included sensitivity and specificity calculations to compare the predictive accuracy of the CASS and BATSS scoring systems. Results: The mean age of the participants was 35.8±12.67 years, with 87% being males. Road traffic accidents were the most common mode of injury (89%). The BATSS scoring system demonstrated higher accuracy in predicting the necessity of surgical intervention after blunting abdominal trauma, with 65.9% sensitivity and 95% specificity compared to the CASS scoring system. Conclusion: The BATSS scoring system shows superior efficacy in predicting the need for surgical intervention following blunt abdominal trauma compared to the CASS scoring system. This suggests that the BATSS score may be a more reliable tool for clinicians in assessing the severity of abdominal injuries and determining the appropriate course of treatment.

DOCETAXEL VERSUS DOCETAXEL PLUS CAPECITABINE AS NEOADJUVANT CHEMOTHERAPY FOR TRIPLE-NEGATIVE BREAST CANCER PATIENTS

RAA KHAN , AI MASOOD , S KHAN , A MASOOD , . ABDULMANAN, A ZULFIQAR — Sat, 06 Jan 2024 00:00:00 +0000

Triple-negative breast cancer (TNBC) poses a significant risk of metastasis and relapse, demanding effective neoadjuvant chemotherapy strategies. This retrospective study aimed to compare the outcomes of a sole docetaxel versus a docetaxel and capecitabine combination (TX) regimen as a neoadjuvant treatment for triple-negative breast cancer. The current retrospective analysis was conducted at the oncology department of Nishtar Hospital Multan and encompassed 80 randomly assigned female patients with triple-negative breast cancer between September 17, 2021, and December 31, 2022. They were further divided into two groups. The TX regimen (docetaxel 75 mg/m2 d1 with capecitabine 800 mg/m2 twice d1-14, q3w) was given to forty patients in the first group named the TX group, where the T regimen (docetaxel 75 mg/m2 d1 q3w) was given to other forty patients assigned in the second group called as T group, over four cycles. The primary endpoint was achieving a pathological complete response (pCR) in the breast, with secondary objectives including pCR in both the breast and axilla, invasive disease-free survival (iDFS), overall 0ne year survival (OS), and safety assessments. In the retrospective analysis, 21 patients in the TX group and 5 in the T group achieved pCR (52.5% vs. 12.5%, p=0.014), demonstrating a statistically significant superiority of the TX regimen. The TX regimen substantially increased pCR incidence (95% CI 2.3-47.1%; p = 0.028) within a subgroup characterized by a high Ki-67 level. The TX group showed a higher incidence of hand-foot syndrome and a statistically insignificant (p > 0.05) incidence of alopecia, presenting a manageable toxicity profile. Comparable iDFS and OS rates were observed in both groups throughout the 12-month average follow-up period. This retrospective analysis indicates that the TX regimen yielded significantly superior results, with a marked increase in pCR rates, particularly in the high Ki-67 subgroup. The observed toxicity profile was manageable, emphasizing the clinical benefits of incorporating capecitabine with docetaxel in neoadjuvant chemotherapy for triple-negative breast cancer patients.

ROLE AND ELEVATING PROGNOSTIC PRECISION OF PIVKA-II AS A SUPERIOR BIOMARKER IN HCC DIAGNOSIS, SURPASSING AFP

M YASEEN , R ANWAR , MM AHMAD , H JAVAID , M SADIA , MR BUTT — Thu, 15 Feb 2024 00:00:00 +0000

The objective of this study was to evaluate the diagnostic accuracy of PIVKA-II as compared to AFP for the detection of hepatocellular carcinoma (HCC) and its potential as a devoid prognostic biomarker. With genomic discoveries, including gene mutations, epigenetic alterations, and non-coding RNAs, the context around HCC biomarkers has increased. The relevance of prognostic and predictive biomarkers is growing as they support treatment choices and evaluate clinical outcomes. These indicators are significant tools in enhancing patient care because they improve diagnosis, direct therapy, forecast outcomes, and evaluate treatment responses. Comprehensive information on the predictive value of several markers, however, is still lacking. In this study, 85 people took part, including those older than 18 with hepatocellular carcinoma in a range of clinical stages. Three groups represented the study population, comprising 85 individuals in total: group 1 consisted solely of patients with HCC, group 2 included patients with benign liver disease, and group 3 was designated as the control group. A male predominance is found in groups, except group 2. The quantity of PIVKA-II in serum was measured using an automated analyzer that was based on the CMIA. The immunoassay method was applied to determine the concentration of AFP. The statistical analyses of PIVKA-II and AFP consisted of sensitivity 90–99% and 58–81%, specificity 68–99%, and 61–98% with a 95% CI, respectively. The findings emphasize PIVKA-II's superior performance as a biomarker of cancer response when compared to AFP.

COMPARISON OF ENDOSCOPIC EAR SURGERY AND MICROSCOPIC EAR SURGERY IN PATIENTS WITH ATTIC CHOLESTEATOMA

S ALI , MZ ISHAQ , S MAJEED , S SAFDAR , KAA KHAN , U KHAN — Mon, 11 Mar 2024 00:00:00 +0000

The study aimed to compare the effectiveness of microscopic and endoscopic approaches in treating attic cholesteatoma, a condition where abnormal skin growth occurs in the middle ear. The research was conducted prospectively at the ENT Department of Nishtar Medical Hospital from January 2021 to January 2023 on 70 patients with chronic suppurative otitis media with cholesteatoma in the epitympanic region. The patients were randomly divided into two groups, with 35 in each group. Both groups were followed up post-operatively at 1st, third, and sixth months, and their hearing was assessed. The study found that five patients (14.2%) in the endoscopic ear surgery (EES) group and three patients (8.5%) in the microscopic ear surgery (MES) group had suspected facial nerve dehiscence according to pre-operative CT images. During the surgery, 11 patients (35%) in the ESS group and seven (20%) in the MES group showed facial nerve dehiscence. Post-operatively, abnormal taste sensation was reported in 28.5% of cases in the EES group and 42.8% in the MES group. The mean postoperative air conduction thresholds in both groups were not significantly different. The success rate was 100% in both groups, and there was no disease recurrence in either group. It was concluded that the surgical outcomes of the conventional microscopic approach and endoscopic ear surgery are comparable regarding taste sensation, post-operative air conduction, and graft success rate. However, ESS showed better results regarding healing time and post-operative pain. Microscopic surgery was significantly slower than endoscopic surgery. In contrast, the average healing time in the endoscopic group was faster than in the microscopic group.

IMPACT OF AGING AND STRESS ON THE PERIODONTAL HEALTH OF THE GERIATRIC POPULATION BEFORE AND AFTER PERIODONTAL TREATMENT IN OLD HOMES OF KARACHI, PAKISTAN

U MUSHTAQUE , A IQBAL , A NAVEED , AA ALI , E SHAHZAD , I ASLAM — Fri, 19 Apr 2024 00:00:00 +0000

Age and stress-related periodontal diseases are prevalent in the geriatric population and continue to provide a significant epidemiological concern. Objective: To assess the impact of ageing and stress on the periodontal health of the senior population before and after periodontal treatment Method: A cross-sectional study was conducted between February and October 2023. Twenty-two senior patients aged 55 to 77 were selected through purposeful random sampling, excluding those unwilling or unable to participate. A semi-structured questionnaire, translated into the native language, assessed periodontal health using the Basic Periodontal Examination (BPE). Informed consent was obtained from participants, who were assured confidentiality and the right to withdraw. Data analysis was performed using SPSS version 23, employing mean and standard deviation for continuous data and frequency tables for categorized data. Cross-tabulation and significance testing were utilized to demonstrate associations. Results: The results of the prevailing cross-sectional study reveal that there exists an association between moderate to elevated levels of perceived stress and the manifestation of severe instances of periodontal disease. As per the study findings, periodontitis tends to afflict individuals across older adult age demographics. Conclusion: The study emphasised that stress and ageing are key risk factors for periodontal diseases, underlining the importance of addressing them during therapy. Consistent oral hygiene can prevent periodontitis in older adults.

PERCUTANEOUS PINNING VERSUS OPEN REDUCTION K WIRE FIXATION IN GARTLAND TYPE III SUPRACONDYLAR HUMERUS FRACTURE IN CHILDREN

A KHAN — Wed, 24 Jan 2024 00:00:00 +0000

This study was carried out to explore the percutaneous pinning versus open reduction K wire fixation in Gartland Type III supracondylar humerus fractures in children. This randomized control trial was conducted at the Department of Orthopaedic and Trauma DHQ Hospital Timergara Lower Dir KPK Pakistan hospital from September 2022 to November 2023. Eighty-four patients participated in this study, which was distributed into two groups. The open reduction and percutaneous pinning groups contained 42 patients each. Both groups were assessed for enhancement in function and radio-logically for fracture union. Children of both genders with Gartland type III supracondylar fractures between the ages of 2 and 12 years were included. In contrast, all children with open fractures, multiple fractures, and systemic diseases like infections such as pneumonia and individuals with cancer were excluded. In the group receiving percutaneous pinning, 33 (78.5%) children had excellent functional outcomes, 7 (16.6%) showed good functional outcomes, and 2 (4.7%) showed fair functional outcomes. In the open reduction group, there were 27 (64.3%) children with excellent functional results, 10 (23.8%) with good functional outcomes, 3 (7.1%) with fair outcomes, and 2 (4.7%) with poor functional consequences (p > 0.05). When treating children with Gartland type III supracondylar fractures of the humerus, percutaneous pinning is the safest and most successful method than open reduction with K wire fixation. Its apparent operative scars and other consequences are modest.

INCIDENCE OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH CHRONIC HEPATITIS C GENOTYPE III AND ADVANCED HEPATIC FIBROSIS AFTER TREATMENT WITH DIRECT-ACTING ANTIVIRALS

S KANJU , UK SHERWANI , A RAZA , S SARWAR , MA WADHAK — Mon, 19 Feb 2024 00:00:00 +0000

A prospective study was conducted at the Gastroenterology Department of Nishtar Hospital from August 2020 to August 2022 to evaluate the incidence of hepatocellular carcinoma (HCC) in chronic hepatitis C (CHC) patients with hepatic fibrosis or cirrhosis, genotype III, who achieved sustained viral response (SVR) after treatment with direct-acting antivirals (DAAs). The study included a total of 500 genotype III patients diagnosed with F3 and F4, who received a 3-month or 6-month course of DAA regimens. HCC was diagnosed by performing triphasic MSCT, and staging was done. During the follow-up, 50 out of 500 patients were diagnosed with HCC. The patients diagnosed with HCC were primarily elderly males and had higher levels of AST, AFP, and bilirubin, as well as reduced platelets and albumin levels compared to non-HCC patients. In cirrhotic patients, the incidence of HCC 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. The study findings suggest that CHC patients with fibrosis and cirrhosis who achieve SVR after treatment with DAAs have a reduced incidence of HCC.

CHALLENGES FACED BY NURSING STUDENTS IN ONLINE EDUCATION DURING THE COVID-19 PANDEMIC

B FARID, M ZAFAR, K RASHEED, H ARSHAD — Mon, 18 Mar 2024 00:00:00 +0000

Amid the COVID-19 pandemic, the transition to online education has posed significant challenges for nursing students worldwide. This study explores the multifaceted obstacles encountered during this shift and aims to provide insights for improving online nursing education. Utilizing a descriptive cross-sectional quantitative research design, data was collected from 73 final-year nursing students at Saida Waheed FMH College of Nursing, Lahore, using a structured questionnaire. The questionnaire assessed various domains, including learning effectiveness, software proficiency, instructor support, communication, course design, and psychosocial experiences. The results revealed a spectrum of student experiences, ranging from perceived benefits to substantial challenges adapting to online learning. While some students reported proficiency in online education tools, others faced difficulties navigating technology and accessing course materials. Instructor support emerged as a critical factor influencing students' satisfaction and learning outcomes, with clear communication and timely feedback paramount. Additionally, challenges related to course design and psychosocial experiences significantly impacted students' engagement and motivation. By comparing these findings with previous research, common themes and areas for improvement in online nursing education were identified. The study underscores the importance of targeted interventions to address technological barriers, enhance instructional support, optimize course design, and prioritize students' psychosocial well-being in online learning environments. Ultimately, these insights can inform the development of effective strategies to enhance the quality and effectiveness of online nursing education programs.

COMPARATIVE ANALYSIS OF STAGED VERSUS INDEX PROCEDURE COMPLETE REVASCULARIZATION IN ST-ELEVATION MYOCARDIAL INFARCTION

SB SHAH , S KHAN — Sat, 30 Mar 2024 00:00:00 +0000

ST-elevation myocardial infarction (STEMI) is a critical condition that necessitates quick and efficient revascularization techniques. Recently, there has been a discussion on the best method for revascularization staged versus index procedure complete revascularization. The study compares the clinical outcomes of staged versus index procedure complete revascularization in ST-elevation myocardial infarction. This study is a prospective comparative analysis conducted at Ayub Teaching Hospital, Abbottabad. The patients were divided into two groups, with 40 participants in each group. Demographic data that included Smoking history, Diabetes mellitus, Dyslipidemia, Previous MI, and (LVEF) was recorded. Intraoperative and postoperative outcomes at 72 hours and six months were recorded. The quality of life was also assessed using SF-36 16. Data was entered and analyzed using SPSS (Statistical Package for the Social Sciences) version 24. P-values of ≤0.05 will be considered statistically significant. These findings suggest that in Group A, the frequency of "No reflow" (1 case) and "Abrupt closure" (0 instances) p=0.02) compared to Group B, where "No reflow" was observed in 2 cases and "Abrupt closure" in 1 case, (and (p=0.01), the investigation into post-operative outcomes, revealed no statistically significant differences between the two groups. P values ranged from 0.31 to 0.45, indicating comparable outcomes. After six months post-surgery, Group A demonstrated significantly better outcomes across various health-related domains than Group B, as indicated by the SF-36 questionnaire. In conclusion, index complete vascularization holds a distinct advantage over staged procedures. The observed differences across various health indicators highlight the potential clinical significance of prioritizing complete revascularization during the initial intervention.

IMPROVING THE ACCURACY OF CALCULATION WEIGHTS BY VISUAL INPUT: A PILOT STUDY IN THE EMERGENCY DEPARTMENT OF A LOW MIDDLE-INCOME COUNTRY

A IRFAN , Z IJAZ , AF ALI , AS KHAN — Wed, 14 Feb 2024 00:00:00 +0000

Accurate weight estimation is critical in emergency medical scenarios requiring immediate interventions. This pilot study explores the feasibility of improving weight calculation accuracy through visual input, focusing on height-based estimations. The research aims to contribute valuable insights to weight estimation methodologies, particularly in resource-constrained settings. The objective of the pilot study is to explore the feasibility of improving weight calculation accuracy through visual input, focusing on height-based estimations. Data was collected encompassing diverse height ranges from 1.45 to 1.94 meters. Comprehensive datasets included actual body weights, estimated weights, standard deviation, and standard error. eBW(kg) = (N− 1)100 is the estimated body weight method, where "N" is the height measured in meters. Body weight classifications were employed to analyze the accuracy of estimations further. Correction factors for everyone were computed. The correction factor separates the obtained data into underweight, close to actual weight, and overweight. Following optimization, the average correction factor for every category is updated. These updated correction factors improve weight estimation precision. Linear regression analyses were conducted to compare actual and estimated weights, visually representing the discrepancies. The calculated correction factors are essential to improving weight calculations in medicine. The thorough research and improvement procedure resulted in revised correction factors significantly improving the precision of weight estimates in the medical field. We can say that the following equation provides a more accurate weight estimate. Wt corrected = (N-1) x 100 x Correction Factor. This revised weight is an enhanced estimate that considers the updated correction factors. The calculated correction variables are essential to improving weight estimations in medicine. The thorough research and improvement procedure resulted in revised correction factors that significantly improved the precision of weight estimations in the medical field. The derived correction factors demonstrate their effectiveness in enhancing weight estimations, notably in specific patient groups. The investigation classifies patients and delivers precise modifications to improve weight estimations, ensuring safer prescribing procedures. The proposed correction variables will be critical in evaluating emergency medicine doses for individuals.

IMPACT OF ANTENATAL STEROID ADMINISTRATION ON NEONATAL RESPIRATORY OUTCOMES

W HAQ , N NAZ , S TAJ , . ARSH, R BHITTANI — Tue, 13 Feb 2024 00:00:00 +0000

The administration of antenatal steroids represents a pivotal intervention in obstetric care with profound implications for neonatal respiratory outcomes. The study's main objective is to find the impact of antenatal steroid administration on neonatal respiratory outcomes. This retrospective cohort study was conducted at Lady Reading Hospital Peshawar from July 2019 to June 2023. The study included all infants born at the hospital who met the criteria for preterm birth (gestational age less than 37 weeks). Maternal demographic information was extracted, encompassing maternal age, parity, and medical history. The data collection's primary focus was antenatal steroid administration, including the type of steroid used, dosage, and timing of the gestational age at delivery. Data was collected from 550 preterm infants. The mean maternal age in the antenatal steroid group was 28.5 ± 4.2 years, and 29.1 ± 4.5 years in the no antenatal steroid group. The mean gestational age was 32.2 ± 2.1 weeks and 31.8 ± 2.3, respectively, in both groups. In the antenatal steroid group (n=300), the majority received betamethasone (90.0%) compared to dexamethasone (10.0%). The timing of administration varied, with 16.7% receiving steroids before 28 weeks, 50.0% between 28-32 weeks, and 33.3% between 32-34 weeks. The mean dosage for betamethasone was 10.5 ± 2.3 mg, while dexamethasone had a mean dosage of 8.0 ± 1.5 mg. It is concluded that antenatal steroid administration was associated with a significant reduction in RDS incidence and a lower need for mechanical ventilation among preterm infants. These findings emphasize the clinical importance of timely antenatal steroid administration in improving neonatal respiratory outcomes.

ANTI-BIO GRAM PROFILE IN THE SETTING OF A HIGH FREQUENCY OF MULTI-DRUG RESISTANT ORGANISMS AT DOCTORS HOSPITAL AND MEDICAL CENTRE, LAHORE, PAKISTAN

Z RIAZ , AA RANA , M KHOSO , MBA KHAN , SU REHMAN , A FARHAN — Tue, 12 Mar 2024 00:00:00 +0000

Antimicrobial resistance (AMR) has emerged as a worldwide concern. The overuse and abuse of antibiotics pose a severe hazard to low-income nations in addition to reducing therapeutic choices. This is a retrospective cross-sectional study conducted at the Doctors Hospital and Medical Center surgical ICU in Lahore between January 1, 2021, and December 31, 2021. Three hundred sixty-four patients' blood, tracheal, and urine culture data were gathered from patients hospitalized in the intensive care unit and processed by CLSI's standard microbiological methods. Stanford University's web-based anti-bio gram and CLSI were used to construct the anti-bio gram. The study examined 364 individuals, and the cultures that were taken from various places included the trachea (13%), urine (33%), and blood (54%). No organism has been identified from blood cultures thus far. Klebsiella (5), Acinetobacter (4), and Pseudomonas (3) were the most frequently isolated species from tracheal cultures and E. coli, with four isolates, followed by Klebsiella with three and Pseudomonas with two isolated from urine cultures. Staphylococcus sp. exhibited 100% resistance to vancomycin and linezolid. For both Acinetobacter and Klebsiella, colistin showed 100% resistance. E. coli was resistant to moxifloxacin (p value= 0.04). Since multidrug-resistant bacteria are often seen in intensive care units (ICUs), we must use caution when prescribing broad-spectrum antibiotics to avoid overtaxing weaker strains. Preventing the spread of resistant isolates in critical wards and preserving ICU patients will have advantageous outcomes.

ANALYSING THE INCIDENCE OF COMPLICATIONS ASSOCIATED WITH KNEE ARTHROSCOPY

J AHMED , A GHAFFAR , MU FAROOQUE , MR KIFAYATULLAH, S HUSSAIN , K ANWAR — Mon, 08 Apr 2024 00:00:00 +0000

Knee arthroscopy is a minimally invasive surgical technique for diagnosing and treating knee conditions. While generally safe, complications can occur, ranging from minor infections to severe nerve damage or septic arthritis. Understanding these complications is essential for optimal patient care. Objective: To explore the occurrence of complications related to knee arthroscopy. Methods: After the ethical approval from the institutional review board, this retrospective cohort study was conducted at JPMC Karachi from 01/09/23 to 29/02/24. Through the non-probability consecutive sampling, patients between ages 18 and 50, either gender and patients undergoing elective arthroscopy procedures were included in the present study. Detailed documentation of difficulties during surgery and recovery, such as infections, blood clots, nerve damage, and mechanical issues, is crucial for assessing the frequency and seriousness of negative outcomes. Results: Synovectomy (79%) followed by Meniscectomy 78% was the common arthroscopic procedure performed. The incidence of complications after the arthroscopic procedure in the present study was 23%. Septic arthritis (33%), followed by Neural, vascular, or ligament injury and superficial infections (20%) were the complications observed in the present study. Conclusion: Arthroscopic knee surgeries are minimally invasive, generally safe procedures with low complication rates. Within this series were 15 (2%) complications, with five occurrences (33%) explicitly involving septic arthritis.

DIAGNOSTIC ACCURACY OF MENTZER INDEX AS A SCREENING TOOL FOR THE DIAGNOSIS OF IRON DEFICIENCY ANEMIA BY TAKING IRON PROFILE AS GOLD STANDARD IN PATIENTS PRESENTING WITH HYPOCHROMIC MICROCYTIC ANEMIA AT TERTIARY CARE HOSPITAL, KARACHI

S IQBAL , W AMIN , S ARSHAD , NU AIN — Sat, 20 Jan 2024 00:00:00 +0000

Anemia is the most prevalent haematological condition in newborns and children. A deficiency of iron necessary for synthesizing haemoglobin causes it. This study used the iron profile as the gold standard for patients with hypochromic microcytic anemia at a tertiary care hospital in Karachi to assess the Mentzer index's diagnostic accuracy for iron-deficient anemia. From January 2021 to December 2022, a cross-sectional descriptive study was conducted in the Department of Pediatrics, NICH, Karachi. With the patient's explicit consent, data was prospectively collected. Those who satisfied the diagnostic requirements totaled 163 patients. While frequency and percentages were used to represent qualitative factors, simple descriptive statistics with mean and standard deviation were used to convey quantitative data. The following metrics were calculated: diagnostic accuracy, sensitivity, specificity, positive and negative predictive values, and a significance level set at p-value ≤0.05. A total of 163 patients with hypochromic microcytic anemia were included in the study; their mean age was 8.23±3.57 years. 78 (47.9 percent) and 85 (52.1 percent) were female. For the diagnosis of iron deficiency anemia, the Mentzer index's sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were determined to be, respectively, 90.1 percent, 90.1 percent, 93.8 percent, 84.6 percent, and 90.8 percent. According to the study's findings, cell-count-based indices—in particular, the Mentzer index—are trustworthy, widely accessible techniques that have a high degree of discrimination power for identifying iron deficiency anemia.

INCIDENCE OF KIDNEY STONES IN KIDNEY TRANSPLANT RECIPIENTS

FE MANAN , KU REHMAN , I ULLAH , DR SHAHINDA — Sat, 17 Feb 2024 00:00:00 +0000

The incidence of kidney stones in kidney transplant recipients is a significant concern within the realm of post-transplant complications. The study's main objective is to find the incidence of kidney stones in kidney transplant recipients. This retrospective study was conducted at the Institute of Kidney Diseases Peshawar from 2017 to 2023. Data was collected from 420 kidney transplant patients. All patients above 18 years with available medical records who underwent renal transplants in IKD and outside IKD and who presented to IKD for follow-up were included in the study—patients with a history of kidney stones before the transplant process were excluded. Demographic information, including age, gender, and pre-transplant comorbidities, was recorded for each patient. Data were collected from 420 patients with kidney transplants. Out of 420 patients, 35 patients developed kidney stones after transplantation. The mean age of the patients who developed stones was 48.7 ± 10.2 years. There were 45.7% male and 54.3% female patients in the kidney stone group. 25.7% of patients had pre-transplant DM. Most kidney stones analyzed in the study comprised calcium oxalate, representing 18 cases, followed by calcium phosphate with eight instances. The correlation analysis revealed that age and gender did not significantly correlate with kidney stone formation in transplant patients, with p-values of 0.32 and 0.17, respectively. It is concluded that kidney transplant recipients exhibit a notable incidence of kidney stone formation, with tacrolimus-based immunosuppressive regimens potentially contributing to this risk. While age and pre-transplant diabetes show trends toward association with kidney stone development.

DOSIMETRIC COMPARISON OF INTENSITY-MODULATED RADIATION THERAPY (IMRT) AND VOLUMETRIC-MODULATED ARC THERAPY (VMAT) IN RECTAL CANCER PATIENTS: A COMPREHENSIVE ANALYSIS

S SHAFIQUE, K KHAN, T BAIDAR , M OKASHA — Thu, 14 Mar 2024 00:00:00 +0000

This study aimed to conduct a thorough dosimetric comparison between two advanced radiotherapy techniques, Intensity-Modulated Radiation Therapy (IMRT) and Volumetric-Modulated Arc Therapy (VMAT), to ascertain the superior modality in terms of dose distribution and organ-at-risk sparing for rectal cancer patients. Thirty-three patients with ECOG performance status 1, aged between 18 to 60 years, diagnosed with Stage II to III rectal cancer, were included in this prospective study. Each patient underwent treatment planning with IMRT and VMAT techniques using Varian system simulation computed tomography scans. The dosimetric analysis encompassed the evaluation of target volume dose homogeneity, conformity, and doses to at-risk organs. The dosimetric comparison was conducted utilizing seven-field IMRT and dual arc VMAT plans. Statistical analysis was performed using paired t-tests and SPSS 20 software. Treatment plan constraints adhered to the RTOG 9406 guidelines, ensuring adequate planning target volume (PTV) coverage, homogeneity index, conformity index, and dose limits for organs at risk, including small bowel V20 (<200cc), bladder V45 (<21Gy), and femoral head V50 (≤30 Gy). Volumetric arc therapy plans demonstrated superior dose homogeneity to fixed-field intensity-modulated plans (p-value = 0.04), particularly in femoral head dose-limiting toxicity (p-value = 0.00). However, intensity-modulated therapy exhibited equivalent or superior performance in other evaluated parameters. Our findings suggest that while VMAT offers advantages in PTV coverage homogeneity and femoral head dose-limiting toxicity, IMRT remains competitive and potentially preferable in certain dosimetric aspects. The choice between IMRT and VMAT should be carefully considered based on individual patient characteristics and treatment goals. This comprehensive dosimetric comparison contributes valuable insights into optimizing radiotherapy planning for rectal cancer patients, potentially guiding clinical decision-making and improving treatment outcomes.

EARLY OUTCOME OF LEFT VENTRICULAR FUNCTION AFTER CORONARY ARTERY BYPASS SURGERY: A SINGLE-CENTER EXPERIENCE

MAI QURESHI , FS ROOMI , SQ ABBAS — Fri, 29 Mar 2024 00:00:00 +0000

Patients with ischemic heart disease and low ejection fraction often exhibit improved outcomes following coronary artery bypass grafting (CABG). Our study aimed to assess the impact of CABG on left ventricular (LV) systolic function and identify predictors of adverse postoperative outcomes. We conducted a prospective cross-sectional study involving 110 CABG patients with a mean age of 56.1 ± 12.2 years and preoperative left ventricular ejection fraction (LVEF) below 50%. Patients were categorized into two groups: group I (n=76, LVEF > 35%) and group II (n=34, LVEF < 35%). In group II, there was a significantly higher prevalence of diabetes mellitus (DM) (p = 0.05) and Euro SCORE II compared to group I (p < 0.001). However, other clinical predictors showed no significant difference between the two groups. Both groups exhibited a significant improvement in LVEF post-surgery (p = 0.05), with comparable in-hospital mortality rates recorded. The study identified DM, significant diastolic dysfunction, and intra-aortic balloon pump (IABP) insertion as predictors of in-hospital mortality (p = 0.001, 0.03, and < 0.001, respectively). These findings suggest a noticeable enhancement in LV systolic function post-CABG, contributing to improved survival rates. However, patients with DM, significant diastolic dysfunction, and those requiring IABP insertion during the perioperative period are at higher risk of mortality. Therefore, targeted attention and specialized care are essential for optimizing outcomes in these high-risk patients.

DIAGNOSTIC ACCURACY OF X-RAY IN DIAGNOSING AVASCULAR FEMORAL HEAD, KEEPING MAGNETIC RESONANCE IMAGING (MRI) AS GOLD STANDARD

FZ SHAKIR , R MELWAN , S MANSOOR , S FAHIM , K KUMARI , DR SHAZMA, S SINGH — Wed, 31 Jan 2024 00:00:00 +0000

Avascular necrosis of the femoral head is a common cause of musculoskeletal disability, and it presents a significant diagnostic and therapeutic challenge. Although patients are initially asymptomatic, avascular necrosis frequently leads to joint destruction, typically before the age of 50. Magnetic Resonance Imaging (MRI) is a non-invasive, rapid, and compassionate diagnostic tool commonly used by clinicians. This study aims to determine the diagnostic accuracy of X-rays in detecting avascular necrosis of the femoral head, using MRI as the gold standard. This Cross-Sectional Validation Study was conducted at the Department of Radiology, JPMC, Karachi, Pakistan. The study was conducted over six months after the synopsis approval, from November 6, 2021, to May 5, 2022. This study included all patients who met the inclusion criteria and visited the JPMC Hospital in Karachi. After explaining the procedure, risks, and benefits of the study, informed consent was obtained from all patients. All patients underwent X-rays, and those diagnosed with avascular necrosis of the femoral head underwent MRI. The collected data was entered into the attached proforma and used electronically for research. The mean age was 48.8±9.2, with 92 (63.0%) male and 54 (37.0%) female patients. The diagnostic accuracy of the X-ray was 82.88% in detecting avascular necrosis of the femoral head, with sensitivity and specificity of 82.05% and 83.82%, respectively. The positive predictive value (PPV) was 53.42%, and the negative predictive value (NPV) was 80.28%, using MRI findings as the gold standard. In conclusion, the use of X-ray in evaluating avascular necrosis of the femoral head was not helpful and comparable to MRI. Therefore, an MRI should be performed in every case of avascular necrosis of the femoral head to achieve an accurate diagnosis. More prospective and well-controlled trials are required to validate the current findings.

POSTOPERATIVE INFECTIONS OF THE LUMBAR SPINE: PRESENTATION AND MANAGEMENT

MI KHAN , A MUNIR , S ULLAH , S MEHBOOB — Sat, 02 Mar 2024 00:00:00 +0000

: Postoperative infections of the lumbar spine pose significant challenges in clinical management and patient outcomes. Despite advances in surgical techniques and perioperative care, these infections continue to occur, leading to increased morbidity and healthcare costs. Understanding the presentation and management of these infections is crucial for optimizing patient care and outcomes. The objective of the study is to assess the prevalence of spinal surgeries, comorbidities, diagnostic modalities, treatment approaches, and their correlations in managing surgical site infections among patients at Khyber Teaching Hospital. Medical records of 800 patients who underwent lumbar spine surgery at Khyber Teaching Hospital from 2020 to 2022 were retrospectively reviewed. Data regarding patient demographics, surgical details, infection characteristics, microbiological findings, treatment modalities, and outcomes were collected and analyzed. Descriptive statistics were used to summarize the findings, and inferential statistics were employed to explore associations between variables. The study comprised 800 spinal surgery patients at Khyber Teaching Hospital, with a mean age of 58 ± (12.3 SD) years. Laminectomy was the most common procedure (43.75%), followed by discectomy (22.5%). Clinical inspection was predominantly used for SSI diagnosis (95.6%), and post-surgical measures included debridement, antibiotics and cultures. Correlation analysis revealed varying associations between surgeries and post-operative symptoms. The Treatment outcomes showed high-resolution rates, with surgical debridement demonstrating the highest efficacy. This study reveals laminectomy as the most common procedure. As laminectomy was the most common procedure done, that’s why SSI was more common in these procedures. Key diagnostic methods for detecting surgical site infections (SSI) was clinical examination of wound status and pus discharge. The study revealed that patients with early surgical debridement had the best outcome in early resolution of infection and wound healing. Thus, Correlation analysis between surgeries and symptoms guides clinical decisions, with surgical debridement followed by antibiotics showing the highest efficacy in resolving infections. These findings stress the need for tailored patient care strategies to enhance outcomes and reduce complications in spinal surgery.

CORRELATION OF TUMOR MARKERS HER2 NEU ER PR AND KI 67 IN BREAST CANCER PATIENTS

MN RASHID , NU HUDA , L RIAZ , RA SHAHID , AM SIDDIQUI , F BUTT — Sat, 06 Apr 2024 00:00:00 +0000

: Every year, more than a million women are diagnosed with breast cancer, and over 700.000 of them have positive for hormone receptors (FIR). The expression of key markers, such as ER and PP, and clinical circumstances show specific biological traits. Risk factors may have a role in the development of some hormone receptor-positive breast cancers. Objective: The objective of this study was to investigate the correlations between key tumor markers, including HER2, ER, PR, ALP, and KI67, in hormone receptor-positive breast cancers. Methods: Tumour tissue samples were collected for histopathology (10% neutral buffered Formalin-fixed paraffin-embedded tissue specimens) during Trucut biopsy or mastectomy at the oncology department of a tertiary care hospital in Karachi from October 2022 to July 2023. Tissues were analyzed under a light microscope for tumor hormone receptors at a tertiary care hospital in Karachi. Results: There were several significant correlations observed between HER 2 NUE, KI 67, ER, and PR. Specifically, a weak negative correlation was noted between HER 2 NUE and KI 67, while weak positive correlations were observed between HER 2 NUE and both ER and PR. Additionally, a weak positive correlation was found between ER and HER 2 NUE, PR, and KI 67, and a weak positive correlation existed between PR and ER, HER 2 NUE, and KI 67. Finally, KI 67 displayed a weak positive correlation with HER 2 NUE, PR, and ER. Conclusions: Her two nurses, ER, ALP, KI 67, and breastfeeding, are significantly and directly related. PR is not significantly related to other mentioned tumor markers.

INCREASING DIVERSITY IN NURSING TO REDUCE HEALTH DISPARITIES AND ACHIEVE HEALTH EQUITY

F SAFDAR , S QADIR — Sat, 17 Feb 2024 00:00:00 +0000

In modern healthcare systems, achieving health equity remains paramount, yet persistent health disparities among diverse populations present significant challenges. The study's main objective is to find the increasing diversity in nursing to reduce health disparities and achieve health equity. This mixed-methods study was conducted in Bahawal Victoria Hospital Bahawalpur from January 2023 till December 2023. The study enrolled a diverse cohort of 550 participants, including registered nurses (RNs), nursing students, nurse educators, and healthcare administrators. Participants were recruited from various healthcare settings, including hospitals, community health centers, and academic institutions. The study included 300 registered nurses (RNs) aged 22 to 65, comprising 75% females and 25% males, demonstrating diverse ethnic representation. Additionally, 150 nursing students aged between 20 and 30 years participated, with 85% females and 15% males, reflecting a diverse demographic composition. Furthermore, 50 nurse educators aged 30 to 55 years were involved, with 60% females and 40% males showcasing diversity. Most participants, comprising 70%, acknowledged that nursing diversity positively impacts patient care and outcomes. However, only 45% felt that their workplace adequately supports diversity initiatives. Regarding healthcare disparities, 60% identified access to care, 50% recognized quality of care, and 45% acknowledged health outcomes disparities as prevalent issues. It is concluded that diversity in nursing holds significant promise for reducing health disparities and advancing health equity. The study's findings underscore the importance of organizational support for diversity initiatives to address systemic barriers in healthcare delivery.

ASSESSMENT OF WORKPLACE DIFFICULTIES FACED BY NURSES WORKING IN TERTIARY CARE HOSPITAL

F ASHRAF , I JAN , A ZAIB — Wed, 13 Mar 2024 00:00:00 +0000

Occupational stress among nurses in government hospitals is a significant concern, impacting individual well-being and patient care quality. This study aimed to assess the prevalence of stress and its contributing factors among nurses in three government hospitals. This study aimed to evaluate the prevalence of stress among nurses in government hospitals and identify the factors contributing to their stress levels. A cross-sectional study involved 400 nurses from tertiary care Hospital. Demographic and workplace data were collected using a self-administered questionnaire, and stress levels were assessed using the Modified Expanded Nursing Stress Scale (ENSS). Most participants were female (70%) and aged between 25 and 35 (55%). Sixty per cent of nurses held a Bachelor's degree, and 40% had a diploma in nursing. Heavy workload was the most common stressor reported (70%), followed by long working hours (60%) and poor working relationships (45%). Binary logistic regression analysis revealed that female nurses were 1.5 times more likely to experience stress than males (p < 0.05). Nurses working more than 40 hours per week had a 1.3 times higher likelihood of experiencing stress (p < 0.05), and those with less than six years of job experience were 1.8 times more likely to report stress (p < 0.05). The study highlights a high prevalence of stress among nurses in government hospitals, primarily attributed to heavy workloads, long working hours, and poor working relationships. Addressing these factors through targeted interventions is crucial to improving the well-being of nurses and enhancing patient care quality.

PREVALENCE OF MORTALITY IN SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS-2 WITH DIABETES MELLITUS

T ULLAH, J SHEHZAD, A AHMAD, AU REHMAN, MT ULLAH, A ULLAH, M ZEESHAN — Mon, 11 Mar 2024 00:00:00 +0000

The coexistence of Diabetes Mellitus (DM) and COVID-19 has garnered considerable attention due to the elevated prevalence of DM among COVID-19 patients. Understanding the impact of DM on the severity of COVID-19 infections is imperative for effective treatment, given the challenges it poses across various healthcare systems. This study aimed to assess the frequency of Type II Diabetes Mellitus among symptomatic COVID-19-positive individuals and calculate the mortality rate among those diagnosed with Type II Diabetes Mellitus contracting COVID-19. Utilizing a cross-sectional approach, 142 samples were randomly selected for analysis to determine the prevalence of Diabetes Mellitus among individuals diagnosed with COVID-19. The findings revealed that out of the 142 COVID-19-positive individuals tested via RT-PCR, 66.2% were diabetic, while 33.8% were non-diabetic. Among the entire sample, 31% of patients succumbed to the infection, while 69.0% achieved full recovery. Specifically, within the diabetic group, 81.8% experienced mortality, with 59.2% recovering fully, whereas among the non-diabetic group, 18.2% passed away, and 40.8% recovered fully. The highest mortality rate was observed among individuals aged 60-74, comprising 45.1% of the total population under observation. The study underscores the elevated mortality risk associated with COVID-19 among diabetic individuals, with a mortality rate of 25.35%, significantly higher than the 5.63% mortality rate observed among non-diabetic individuals. Notably, the vulnerability to COVID-19 and increased mortality rates were particularly pronounced among individuals aged 45-74, with a notable emphasis on the heightened risk among those aged 60-74. Furthermore, the study found no significant disparity in mortality rates between male and female patients. These findings shed light on the heightened susceptibility of diabetic individuals to severe outcomes of COVID-19 and underscore the importance of targeted interventions and preventive measures, especially among the elderly diabetic population.

EPIDEMIOLOGICAL STUDY OF TYPHOID FEVER PREVALENCE AMONG SUSPECTED CASES IN RAWALPINDI AND ISLAMABAD: IMPLICATIONS FOR PUBLIC HEALTH INTERVENTION

S YASMEEN , T PARVEEN , K NAZAR — Sun, 10 Mar 2024 00:00:00 +0000

Typhoid fever remains a significant public health concern in Pakistan, particularly in urban areas such as Rawalpindi and Islamabad. Understanding the prevalence of this disease is crucial for informing public health interventions and resource allocation. This study aims to determine the prevalence of typhoid fever among patients suspected of the disease in District Rawalpindi and Islamabad. A cross-sectional study was conducted over three months, from November 2011 to January 2012. A random sample of 500 patients suspected of typhoid fever was collected from various regional hospitals and clinical laboratories. Samples were tested using the Widal test or Typhi dot, and data on patient demographics and test results were recorded. Descriptive statistics, including frequencies and percentages, were used to summarize the data. Prevalence rates were calculated, and subgroup analyses were conducted to explore variations in prevalence among different age groups. Of the 500 samples collected, 95 tested positive for typhoid fever, yielding an overall prevalence rate of 19%. Subgroup analysis revealed that 31.5% of positive cases were in adults, while 68.5% were in children under the age of 15 years. Among children, the prevalence rates varied across different age groups, with 13.8%, 55.3%, and 30.7% of positive cases reported in 1-4 years, 5-12 years, and 12-15 years, respectively. Further analysis estimated the total prevalence of typhoid fever in Rawalpindi and Islamabad, revealing a prevalence rate of 685 per 10,000 individuals among children. This study highlights the significant burden of typhoid fever in Rawalpindi and Islamabad, particularly among children. The findings underscore the importance of targeted interventions to control the spread of the disease, including vaccination campaigns and improved sanitation measures. Continued surveillance and monitoring are essential for tracking trends in typhoid prevalence and guiding regional public health strategies.

THE USEFULNESS OF CORONARY CTA IN IDENTIFYING CASES OF CORONARY ARTERY DISEASE

F KALSOOM , S TARIQ , U ZAFAR , K MUSHTAQ — Mon, 01 Apr 2024 00:00:00 +0000

Ischemic heart disease is the leading cause of mortality worldwide. A complete diagnosis assessment is essential for patients with suspected CAD since it influences many treatment decisions. Invasive coronary angiography is the gold standard for detecting CAD. Objective: To investigate the diagnostic effectiveness of coronary computed tomography angiography (CTA) in diagnosing coronary artery disease. Method: This cross-sectional research comprised 100 patients with suspected coronary artery disease admitted to the Chaudhary Pervez Ellahi Institute of Cardiology Hospital between March 2022 and March 2023. All patients received a coronary CTA and coronary angiography. The findings of the patients' coronary CTAs and coronary angiography were evaluated. The practical uses of coronary CTA in the identification of CAD were investigated, as well as the identification and coincidence frequency of coronary CTA for assessing the degree of coronary stenosis. Results: There were no significant differences between coronary CTAs and coronary angiographies in detecting positive CAD or coronary stenosis. Regarding identifying coronary artery disease, coronary CTA had a sensitivity of 81.69% (58/71) and a specificity of 75.8% (22/29). The positive predictive value was 90.6% (58/64), while the negative predictive value was 62.8% (22/35). The coronary CTA findings revealed that 18 patients had coronary stenosis of no more than 70% and 40 patients had coronary stenosis of more than 70% among the total 58 patients with coronary artery disease that were found using both coronary angiography and coronary CTA. According to the findings of the coronary angiography, there were 37 patients with coronary stenosis greater than 70% and 21 patients with coronary stenosis below seventy percent. P value p=0.326 indicates that no significant differences were detected. Conclusions: In conclusion, coronary CTA has a beneficial and valuable role in the early detection of CAD. It is non-invasive and simple to use. Furthermore, coronary CTA can precisely find the locations of coronary stenosis and determine the degree of stenosis. As a result, it merits widespread adoption as a CAD screening tool.

AWARENESS AND HEALTH SEEKING BEHAVIOUR OF PARENTS REGARDING THEIR CHILDREN’S ORAL HEALTH AND PROFESSIONAL DENTAL CARE

N NOREEN , H FATEMAH , J YOUSFANI , A MANSOOR , E MANSOOR , H ULLAH — Wed, 17 Jan 2024 00:00:00 +0000

Parents' awareness and health-seeking behaviour concerning their children's oral health and professional dental care are vital components shaping pediatric dental wellness. The study's primary objective is to find parents' awareness and health-seeking behaviour regarding their children’s oral health and professional dental care. This cross-sectional study was conducted in Karachi. Data was collected from 320 parents who participated in this study. To capture a comprehensive understanding, participant recruitment involves a diverse selection of parents, ensuring representation across various demographics, including age, socioeconomic status, educational background, and geographical location. Data were collected from 320 participants. Participants belong to different age groups. Respondents with a high school education or less constituted 35%, while those with a bachelor's degree represented 30% of the participants. The survey outlined varying degrees of parental awareness regarding specific oral health practices. While a high percentage of parents were aware of the importance of fluoride use for children (85%) and the ideal age for dental check-ups (60%), adherence to the American Academy of Pediatric Dentistry (AAPD) brushing recommendations and awareness of proper flossing techniques were notably lower, at 25% and 40%, respectively. It is concluded that early dental checkups play a crucial role in preventing conditions like dental caries. Founding good oral habits and hygiene during the formative years significantly contributes to lifelong oral health in children.

PREVALENCE AND PATHOPHYSIOLOGY OF POST-THYROIDECTOMY HYPOCALCAEMIA

S NOORUDDIN , Z KHAN , A ALI, WF ALHUJAILI, SA BABEKIR, A SAEED — Mon, 25 Mar 2024 00:00:00 +0000

Post-thyroidectomy hypocalcemia is a recognised and potentially significant complication arising from the surgical removal of the thyroid gland. The study's main objective is to find the prevalence and pathophysiology of post-thyroidectomy hypocalcemia. This prospective observational study was conducted in Civil Hospital Quetta from June 2021 to July 2022. A total of 162 patients undergoing thyroidectomy for various indications, including thyroid cancer, hyperthyroidism, and goiter, were enrolled in the study. Before surgery, baseline data were gathered, including demographic information, medical history, and preoperative serum calcium and parathyroid hormone (PTH) levels, from the 162 enrolled patients scheduled for thyroidectomy. Data were collected from 162 patients from both genders. The mean age of patients was 48.5 ± 8.2 years, with 70% female. The diagnoses included 40% with thyroid cancer, 30% with hyperthyroidism, and 30% with a large goiter. Preoperative serum calcium levels were 9.0 ± 0.5 mg/dL, parathyroid hormone (PTH) levels were 45 ± 9.80 pg/mL, and vitamin D levels were 25.5 ± 6.3 ng/mL. A history of hypocalcemia was noted in 5% of the participants. The mean serum calcium level was 9.0 mg/dL, with a standard deviation of 0.5. However, at 48 hours post-op, there was a decrease in the mean serum calcium level to 7.8 mg/dL, with a standard deviation of 0.7. It is concluded that the interaction between reduced serum calcium and parathyroid hormone levels highlights the immediate impact of surgery on calcium homeostasis.

LEVEL OF JOB SATISFACTION AMONG REGISTERED NURSES WORKING IN CLINICAL AREA AT TEACHING HOSPITAL: A STUDY FROM LOCAL POPULATION

R NAWAZ , T PERVEEN , K NAZAR — Sun, 10 Mar 2024 00:00:00 +0000

Job satisfaction is crucial to a nurse's life, impacting patient safety, productivity, performance, quality of care, and commitment to the organization and the profession. The objective of this study was to evaluate the level of job satisfaction among registered nurses working at different local hospital of Multan, Punjab, Pakistan. The study employed a cross-sectional descriptive survey design with a sample of 102 registered nurses selected through random sampling. A self-reported questionnaire was used to collect data, and the inclusion criteria were comprised of female regular nurses registered with the Pakistan Nursing Council. Primary data was collected through semi-structured interviews, and secondary data, which consisted of 30 questions, was collected. All participants in this study were female, most of whom were aged between 26 and 30 (53.92%). Most respondents (89, 87.3%) had a diploma in general nursing, and most had working experience ranging from 6 months to 5 years (49, 48.0%). The majority of the respondents were married (58, 56.9%). Out of 102 respondents, 63 (61.77%) were satisfied, 45 (44.12%) were neutral, and 14 (13.72%) were dissatisfied. The corresponding percentage in the satisfied category (61.77%) is higher than in the remaining categories. Nurses are not entirely satisfied with their work. The level of job satisfaction among nurses varies with age, qualification, working experience, and marital status. At different local hospital of Multan., nurses are not fully satisfied with their jobs due to more patients than staff nurses, low salaries, job insecurity, lack of opportunities for promotion, and no daycare center for the duty staff's children.

FREQUENCY OF LOW BACK PAIN AND ITS IMPACT ON MEDICAL STUDENTS OF BILAWAL MEDICAL COLLEGE: A RETROSPECTIVE SURVEY

Fri, 19 Apr 2024 00:00:00 +0000

Low back pain (LBP) is a significant health and economic problem among populations in high-resource countries. LBP is one of the prevalent complaints among all age groups. Objective: To assess the frequency of low back pain (LBP) among medical and its impact on their daily activities and life while exploring potential associations with socio-demographic factors, exercise habits, pain-relieving consumption, history of spine trauma, and body mass index (BMI) Methods: A retrospective survey was conducted at Bilawal Medical College (BMC) among first year to final year MBBS students. Data was collected during the period of January 2022 to February 2023 using a questionnaire created on Google Form that included questions regarding the information on socio-demographic characteristics and factors such as exercise, pain-relieving consumption, any history of spine trauma, specific questions pertaining to LBP pain frequency and issues. Results: A total of 62 medical students participated in the study, of which about half were in their fourth year (50.0%), followed by the third year (20.9%) of medical school. The 20–24 age group accounted for most individuals (64.5%), followed by the 25–30-year-old age group (33.9%). Only 25.8% of the participants were overweight, defined as having a BMI of more than 25 kg/m2. Conclusion: It was concluded that low back pain is one of the most frequent health crises among medical students. Students from senior academic years reported more frequent lower back pain, which was highly significant due to increased mental stress and increased physical strain due to clinical learning. Additionally, it was found that there is no potential link between BMI and a history of spine trauma on the frequency of lower back pain or its impact on the medical student's life and their daily activities.

INCIDENCE OF CONVERSION TO OPEN APPENDECTOMY FROM LAPAROSCOPIC APPENDECTOMY IN PREGNANT FEMALES

SSU HASSAN, T MAHAR, B ZAHRA — Sat, 03 Feb 2024 00:00:00 +0000

Acute appendicitis is a common non-obstetric indication for surgery in pregnant women, and the choice between laparoscopic and open appendectomy remains a subject of debate. While the benefits of laparoscopic appendectomy over open surgery are well-established in the non-pregnant population, consensus is lacking in the pregnant cohort. This study aims to contribute insights into the optimal surgical approach for acute appendicitis in pregnant women. The study, conducted from January 2020 to December 2022 at Nishtar Hospital, Multan, focused on 45 pregnant women presenting with abdominal pain and diagnosed with acute appendicitis. Two patients were discharged after magnetic resonance imaging (MRI) revealed a normal appendix. Of the remaining 43 cases, 27 were in the first trimester, 8 in the second trimester, and 8 in the third trimester. All patients underwent successful laparoscopic appendectomy without any conversion to open surgery. The laparoscopic procedure duration ranged from 50 to 80 minutes, with an average postoperative hospital stay of 1.5-3 days. Postoperative wound infection occurred in three patients (6.66%), and two patients (4.44%) experienced preterm labor. Fetal outcomes, assessed through Apgar grading, size, and weight, showed no notable abnormalities after birth. Laparoscopic appendectomy, regardless of gestational age, proves generally safe and suitable for pregnant women with acute appendicitis. The procedure has minimal complications, making it a viable and preferred option during pregnancy. These findings advocate for the continued consideration of laparoscopic appendectomy as a standard approach for managing acute appendicitis in pregnant patients.

SPINAL ANATOMY AND BEYOND: INVESTIGATING DEGENERATIVE DISC DISEASE

QUA KHAN , F MALIK , A REHMAN , SAZ NAQVI , F AZHAR — Wed, 06 Mar 2024 00:00:00 +0000

Degenerative disc disease is a common manifestation in routine spine imaging; this finding is partly attributable to physiological aging and partly to a pathological condition, and sometimes, this distinction is simply not clear. The study's main objective is to find the spinal anatomy and investigate degenerative disc disease in spinal patients. This mixed-methods study was conducted in a public hospital in Karachi, Pakistan from March 2023 to September 2023. Fifty patients diagnosed with DDD are enrolled, with comprehensive clinical assessments conducted to evaluate symptomatology, functional impairment, and radiological findings. Additionally, advanced imaging modalities, including MRI and CT scans, elucidate structural changes within the spinal column. Preliminary analysis reveals a mean disc height loss of 3.2 mm (±0.8) across the study cohort, with significant variability observed among individual patients. Annular tears are prevalent in 70% of cases, predominantly localized to the lumbar spine. Furthermore, facet joint degeneration is evident in 85% of patients, with a mean grade of 2.4 (±0.6) on the Pfirrmann scale. Correlation analysis demonstrates a moderate positive correlation (r = 0.56, p < 0.001) between disc height loss and severity of clinical symptoms. It is concluded that this study provides the complex pathology of degenerative disc disease (DDD) and its impact on spinal anatomy. Through a comprehensive investigation involving clinical assessments and advanced imaging techniques, we have elucidated the spectrum of degenerative changes within the intervertebral discs and facet joints.

INVESTIGATING RADIOLOGICAL INSIGHTS OF BREAST CANCER WITH AGE AT JINNAH POSTGRADUATE MEDICAL CENTRE, KARACHI

KA SALDERA , TA KHAN , UBK SAMO , S MEHBOOB — Mon, 01 Apr 2024 00:00:00 +0000

There is a conflicting opinion regarding the association between age and breast cancer in women. This study was conducted to investigate the histopathological findings of findings and features of diagnosed patients of breast cancer about their age and radiological findings of lesions and to determine the relation of aggressive findings in different age groups. Methods: A cross-sectional study was conducted in the Radiological Department, JPMC, Karachi, from September 2022- September 2023. To ascertain if the histological characteristics of the tumors were connected to the age of the patient, the histology reports of 100 women with breast cancer diagnoses underwent examination. Grading of their cancer based on BIRAD Classification was done on the radiological findings of ultrasound and mammography. Patients between 15 and 65 years were split into five different age groups. Patients who were naive and had never had any surgical or medicinal treatment for cancer before were included. After obtaining consent, a detailed questionnaire with the required data and physical and chemical parameters was completed. Tissue samples in studies mainly included trust biopsies, large mass removal, and tissues from mastectomies. Results: People under the age of 40 were shown to have a higher incidence of grade III infiltrating ductal carcinoma (P 0.0001). Lobular carcinomas were observed more frequently in the elderly group. With advancing age, there was a discernible decline in lymphoplasmacytic stromal response, axillary lymph node metastases, and vascular invasion, all unaffected by tumor grade. Conclusion: These findings imply that the histology of breast cancer may alter with age and that older patients may exhibit less aggressive characteristics in some circumstances.

APPROACH AND UNDERSTANDING OF SURGICAL TRAINEES TOWARDS THE USE OF UNIVERSAL ACS-NSQIP SURGICAL RISK CALCULATOR, AND CLINICAL DATA KEEPING AND ITS AUDIT

B JAWAID , F ZAHEER , MA SHARAFAT , S SALMAN , DR KOMAL, H SHAHAB — Mon, 08 Jan 2024 00:00:00 +0000

Clinical audit methods and surgical risk calculators are paramount in advancing surgical protocols and enhancing patient outcomes. The objective is to assess surgical trainees' approach and understanding of using the Universal ACS-NSQIP Surgical Risk Calculator and clinical data keeping and its audit to improve surgical practices and patient outcomes. A cross-sectional study was administered among 71 surgical trainees at Dr. Ruth K. M. Pfau Civil Hospital Karachi to assess their understanding, perspectives, and behaviors about using the risk calculator and procedures for data management. To gather this information, a questionnaire-based survey was utilized to collect data, which was analyzed via SPSS. The participants displayed limited familiarity (9.9%, n=7) and implementation (0%) of the ACS-NSQIP Surgical Risk Calculator in the clinical practice of surgical trainees. Despite most participants expressing confidence in the calculator's reliability (71.4%) and advocating for its integration into surgical practice (85.7%), its utilization remains non-existent. Moreover, while every participant acknowledged the significance of mantaining patient records and conducting audits, only 22.5% reported participating in clinical data audits. Furthermore, most surgical residents relied on clinical intuitions and conventional sources such as textbooks for patient consultations. There is a notable gap between the comprehension and utilization of the Universal ACS-NSQIP Surgical Risk Calculator among surgical residents. This research emphasizes the necessity to comprehend and utilize for incorporating evidence-based instruments such as the Universal ACS-NSQIP Surgical Risk Calculator and implement rigorous data management and review protocols to cultivate a culture of quality enhancement and optimize patient outcomes. This can be attained through initiatives such as educational programs, enhanced availability of resources, and improved assistance for the compilation and evaluation of data.

PREDICTORS OF ATYPICAL CHEST IMAGING IN PATIENTS WITH PULMONARY TUBERCULOSIS

A SHAKIR , S MAZHAR , A NOREEN , I SHAHZAD , NA BUGVI , Z SHAHID — Fri, 01 Mar 2024 00:00:00 +0000

This study aimed to identify the risk factors associated with abnormal chest imaging in patients diagnosed with pulmonary tuberculosis. A retrospective study was conducted between December 2022 and December 2023 in the Radiology Department of Mayo Hospital, Lahore. The study included 100 patients who were diagnosed with smear-positive pulmonary tuberculosis and had undergone chest computed tomography (CT) within two weeks before or after hospital admission. Patients' performance status was assessed on a scale of 0-4. CT scans were performed on all patients, and radiologists were unaware of the patient's data. They examined the scans to determine the presence of lung involvement (upper, middle, and lower) and cavity. Out of 100 patients, 48 (48%) had non-cavity disease. Univariate analysis revealed that patients with non-cavity disease were most likely to be female, older, and have low estimated glomerular filtration rate (eGFR) and C-reactive protein (CRP) levels compared to patients with cavities. In multivariate analysis, low CRP levels were found to be the most potent risk factor for non-cavity disease after adjusting for co-variables. Additionally, 70 patients (70%) presented with non-upper predominant lung disease. Univariate analysis revealed that the majority of patients in this group were women and had high CRP levels, low albumin levels, and poor performance status. Poor performance status was the most potent risk factor for non-upper predominant lung disease. Based on the study findings, low C-reactive protein levels and poor performance status are the most substantial risk factors for non-cavity and non-upper predominant lung disease, respectively, in patients with pulmonary tuberculosis.

ASSESSMENT OF COMPLETE BLOOD COUNT AND LIVER ENZYMES IN CHRONIC KIDNEY DISEASE PATIENT

A SHAFIQUE , H JAVAID , H BAJWA , R ANWAR , M YASEEN , . SANA — Mon, 11 Mar 2024 00:00:00 +0000

Chronic renal failure (CRF) poses a significant global health challenge, with chronic kidney disease (CKD) characterised by kidney damage or a glomerular filtration rate (GFR) persistently below 60 ml/min for over three months. This observational study, conducted in Faisalabad from January to July 2023, aimed to evaluate haematological variables and liver enzymes across different stages of CKD. Using non-probability purposive sampling, 144 CKD patient files and 48 healthy control files were collected, excluding specific conditions. CKD staging was determined using the Modification of Diet in Renal Disease (MDRD) algorithm, categorizing patients into mild (Group A), moderate (Group B), severe (Group C) CKD, and controls (Group D). Data analysis was performed using SPSS v23. Mean ± SD values were presented for each parameter across the four groups. Haemoglobin levels (Hb g/dl) exhibited a decreasing trend in CKD patients compared to the control group, with values of 13.7 ± 1.50 in controls, 11.7 ± 0.64 in Group 1, 9.7 ± 0.57 in Group 2, and 6.7 ± 1.5 in Group 3. Red blood cell count (RBCs per million/mm3) also decreased progressively in CKD patients compared to controls, with values of 5.48 ± 0.59, 4.62 ± 0.15, 3.57 ± 0.28, and 2.81 ± 0.23 in the respective groups. Conversely, white blood cell counts (WBC thousand/mm3) increased with CKD progression, showing values of 8406 ± 1383 in controls, 10674 ± 1006 in Group 1, 12028 ± 643.5 in Group 2, and 13564 ± 741.29 in Group 3. Similarly, platelet counts (lakh/ul) exhibited a decreasing trend in CKD patients compared to controls, with values of 324708 ± 112970, 235458 ± 63853, 144979 ± 6935.8, and 126333 ± 4768.3, respectively. Analysis of liver enzymes revealed a progressive decrease in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels as CKD advanced. AST levels (U/L) decreased from 29.104 ± 3.130 in controls to 7.5825 ± 1.543 in Group 3, while ALT levels (U/L) decreased from 48.145 ± 4.9679 in controls to 12.270 ± 3.3500 in Group 3. Our findings demonstrate that haemoglobin, red blood cell count, platelet count, and liver enzyme levels (AST and ALT) decrease as CKD progresses while white blood cell count increases. These insights into haematological and hepatic biomarkers underscore the dynamic nature of CKD pathology and may inform clinical management strategies.

AWARENESS, UTILIZATION, AND SATISFACTION OF SEHAT CARD PLUS AT A TERTIARY CARE HOSPITAL IN KHYBER PAKHTUNKHWA: A CROSS-SECTIONAL STUDY

SS IMRAN , M IQBAL , H SHER , S BATOOL — Mon, 25 Mar 2024 00:00:00 +0000

Over 930 million individuals worldwide face significant financial barriers when seeking essential healthcare services, with more than 100 million people annually being pushed into extreme poverty due to healthcare expenses. The main objective of this study is to find the awareness, utilization, and satisfaction of Sehat Card Plus at a tertiary care hospital in Khyber Pakhtunkhwa. This cross-sectional study was conducted at a private tertiary care hospital in Peshawar, Khyber Pakhtunkhwa, from August 2022 to January 2023. The study included 463 patients visiting the tertiary care hospital. A structured questionnaire was developed to gather data on participants' awareness of the Sehat Card Plus program, their utilization of the card for healthcare services, and their satisfaction with its benefits and coverage. Data was collected from 463 patients. The mean age was 42±11.5 years, with 45% female and 55% male participants. Socioeconomic status analysis revealed that 67% of participants belonged to low-income households, while 17% were classified as middle-income and 16% as high-income. 82% of respondents were aware of the Sehat Card Plus program, with television/radio being the most common source of awareness (33%), followed by word of mouth (29%) and social media (27%). However, only 73% knew who was eligible for the program, and 53% knew the services covered. It is concluded that awareness of the Sehat Card Plus program is notable, but substantial gaps exist in understanding eligibility criteria and covered services among participants. Satisfaction with services under this program is moderately high, and the population has a significant demand for the government to introduce similar schemes.

COMPARISON OF DENTAL EXTRACTION ANXIETY AND DEPRESSION BETWEEN YOUNG AND OLDER ADULTS

Wed, 31 Jan 2024 00:00:00 +0000

Dental anxiety and depression represent significant psychological factors that can influence an individual's willingness to seek and undergo dental treatments, including routine procedures such as dental extractions. The main objective of the study is to find the comparison of dental extraction anxiety and depression in young adults as compared to older adults. This cross-sectional study was conducted in Karachi from January 2023 to November 2023. Data was collected from 320 participants in two age groups: young and older adults. Young adults age 8-35 years and older adults 60 years and above. Demographic information, including age, gender, education level, and dental history, was gathered alongside clinical details such as the type and complexity of dental extractions. Validated scales, notably the Modified Dental Anxiety Scale (MDAS) for dental anxiety and the Patient Health Questionnaire-9 (PHQ-9) for depression were employed for assessment. Data were collected from 320 participants. Approximately 36% of the population is estimated to be affected by dental anxiety, with 10 to 20% experiencing extreme levels. The mean Modified Dental Anxiety Scale (MDAS) scores differed significantly between age groups, with young adults having a mean score of 16.2 (SD=4.5) compared to older adults with a mean score of 14.5 (SD=3.8) (p<0.05). Similarly, the mean Patient Health Questionnaire-9 (PHQ-9) scores varied significantly between age groups, showing that young adults had a higher mean score of 8.3 (SD=3.2) compared to older adults with a mean score of 6.7 (SD=2.8) (p<0.01). It is concluded that gender and educational influences further emphasize the need for personalized approaches in dental care. Tooth extraction anxiety and depression are common in older adults. These insights highlight the potential for integrating mental health considerations into routine dental practices, fostering more patient-centered and age-specific interventions to enhance oral health and well-being.

ANALYSIS BETWEEN THE THICKNESS OF ALVEOLAR BONE AND POSITION OF INCISOR IN CLASS I AND II MALOCCLUSIONS THROUGH LATERAL CEPHALOGRAMS

S SHABBIR , H PERVEZ , A WASAN , R TARIQ , RA KHAN , F JAHANGIR — Thu, 29 Feb 2024 00:00:00 +0000

To assess the inclination of incisors and thickness of alveolar bone in malocclusions of Class I and Class II. A comparative study was conducted on 114 individuals in which incisor inclinations and their relationships with the alveolar bone were assessed by using lateral cephalograms. In the study individuals with Class I malocclusion, with a mean age of 18.6 years were recruited along with the individuals of Class II malocclusions with a mean age of 18.27 years. Almost, 114 lateral cephalograms were taken from the individuals. Out of them, 51 had class II malocclusion and 63 had class I malocclusion. The overall mandibular alveolar thickness showed no statistically significant difference between class I and class II malocclusion (P=.086), while there was a slight but statistically significant variation in the maxillary alveolar thickness (P=0.029). There was no significant distinction in the maxillary incisor inclination between the two groups (P=.603), whereas the root apex location lower labial was considerably more posterior (P <.001). However, it was discovered that Class II malocclusion patients had a substantially higher mandibular incisor inclination (P=.004). In the study, the position of the mandibular incisor root apex varied significantly across classes I and II. The mandibular incisor root apex was therefore more posteriorly positioned in class II relative to the alveolar center.

COMPARISON OF OUTCOME (IN TERMS OF RECURRENCE) OF INCISION & DRAINAGE VERSUS ASPIRATION OF BREAST ABSCESS

SSU HASSAN , T HIRAJ , A NADEEM — Wed, 03 Apr 2024 00:00:00 +0000

Breast abscesses can lead to significant morbidity and have a negative impact on quality of life. This study aimed to compare recurrence rates after incision and drainage versus aspiration techniques in managing breast abscesses. Objective: To compare the outcome of incision and drainage versus aspiration techniques in managing breast abscesses, specifically recurrence rates. Methods: This study employed a Randomized Controlled Trial design and was conducted at the Department of General Surgery, Nishtar Hospital, Multan, over a period of six months from July 1, 2019, to January 1, 2020. A total of 60 patients meeting the inclusion criteria were randomized into two groups: Group A underwent needle aspiration, while Group B underwent incision and drainage. Both groups received a 10-day course of tab. Ciprofloxacin 500mg BD and tab danzen DS BD. The researcher performed all the procedures. Patients were followed for two weeks, and recurrence of the abscess was recorded as either "yes" or "no". Results: The study included 60 patients with a mean age of 25.58 ± 3.64 years. Of these, 35 (58.3%) were from rural areas and 25 (41.7%) from urban areas. Seventeen (28.3%) patients were unmarried, and 43 (71.7%) were married. The mean body mass index was 25.12 ± 1.97 kg/m², with obesity present in 7 (11.7%) patients. Thirty-five (58.3%) patients were lactating, with a mean abscess duration of 3.25 ± 0.57 months. The mean abscess size was 1.20 ± 0.18 centimeters, with 55 (91.7%) abscesses ≤ 2 centimeters in size. Diabetes was not present in any patients. Recurrence occurred in 15 (25.0%) patients, with a recurrence rate of 13.3% in Group A and 36.7% in Group B (p = 0.072). Conclusion: The recurrence of breast abscesses was lower in the aspiration group compared to the incision and drainage group. These findings support the use of needle aspiration techniques for the management of breast abscesses. Surgeons treating such patients should consider employing aspiration techniques to achieve better outcomes, thereby reducing the burden of related morbidities and mortalities.

PERSISTENT LEFT SUPERIOR VENA CAVA AND ITS ASSOCIATION WITH CONGENITAL HEART DISEASE: A CT ANGIOGRAPHY STUDY

Thu, 04 Jan 2024 00:00:00 +0000

Persistent Left Superior Vena Cava (PLSVC) is a common venous anomaly that is often associated with congenital heart disease (CHD) in pediatric patients. The significance of this anomaly lies in the potential complications that may arise during cardiac procedures. A prospective observational cohort study was conducted at the Peshawar Institute of Cardiology, a tertiary care heart facility in Peshawar, from January 2021 to January 2022. The study used CT angiography to assess the prevalence and characteristics of PLSVC in a cohort of 75 pediatric patients with CHD. The study also intended to provide valuable insights for preoperative planning and procedural success, addressing the challenges posed by PLSVC in the context of congenital heart anomalies. Demographic data, including age, gender, and clinical history, were collected for all 75 pediatric patients with CHD. CT angiography was used to identify PLSVC, and characteristics such as dimensions, trajectory, and drainage patterns were recorded. Data analysis involved descriptive statistics, chi-squared tests, and a significance level of p < 0.05. The study found that Tetralogy of Fallot (TOF) was the most prevalent CHD, constituting 26.7% of cases. The prevalence of PLSVC varied between males and females. Furthermore, the analysis of PLSVC drainage patterns demonstrated associations with specific types of CHD, providing a comprehensive understanding of the diverse manifestations of this anomaly. In conclusion, this study contributes valuable insights into the prevalence and characteristics of PLSVC in pediatric patients with CHD. The findings emphasize the importance of considering gender-specific and CHD-specific factors in medical interventions. These results have implications for clinical practice and future research in pediatric cardiology.

FREQUENCY OF ACUTE KIDNEY INJURY IN PATIENTS POST-CORONARY ARTERY BYPASS GRAFTING AT TERTIARY CARE HOSPITAL, KARACHI

HU TAREEN, A HAIDER, M SADIQUE, MU BAIG, F KHALIL, T TAHIR , S YAQUB — Sun, 04 Feb 2024 00:00:00 +0000

A descriptive study was conducted at the Department of Medicine and Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, from May 27, 2019, to November 27, 2019, to determine the frequency of acute kidney injury in patients after coronary artery bypass grafting. A total of 174 patients who underwent coronary artery bypass graft surgery were enrolled in the study. Postoperatively, all patients were closely observed for acute kidney injury up to 48 hours post-surgery. The demographic characteristics of the participants revealed a mean age of 54.14±9.49 years, with 108 (62.1%) being males and 66 (37.9%) females. Out of the total participants, 25 (14.4%) experienced acute kidney injuries, while 149 (85.6%) did not show any signs of acute kidney injuries. The findings suggest that acute kidney injury is a common complication following isolated coronary artery bypass graft (CABG) surgery. This observation holds significant clinical importance, as it is associated with unfavourable postoperative outcomes, prolonged stays in the intensive care unit (ICU), and elevated fatality rates. These insights underscore the need for careful monitoring and management of renal function in patients undergoing CABG surgery to mitigate the impact of acute kidney injury on overall postoperative well-being.

COMPARISON OF ROPIVACAINE ALONE VS ROPIVACAINE WITH METHYLPREDNISOLONE INJECTION AS A TREATMENT OF TRIGGER POINTS FOR MYOFASCIAL PAIN: A SUPERIORITY RANDOMIZED CLINICAL TRIAL

S MUSHTAQ , KM BHATTI , Q NAWAZ , K BASHIR , AUR GHAFOOR — Mon, 11 Mar 2024 00:00:00 +0000

Soft tissue rheumatism, known as myofascial pain syndrome (MPS), is typified by taut bands, transferred pain that is distinct, sensory alterations that occur, and a local twitch response. It is also connected with trigger points in one or more muscles. The purpose of the research is to evaluate the effects of injections of Ropivacaine alone vs. Ropivacaine with methylprednisolone in decreasing pain in people in our community who have myofascial pain caused by trigger points. The design of this study was a randomized controlled trial. This study was carried out from July 2022 to August 2023. The research comprised 50 individuals (27 females and 23 males) diagnosed with MPS who came to our clinic. Using online randomization software, the patients were randomly divided into two groups. Group B got a mixture of 0.25% Ropivacaine & 10mg methylprednisolone in 3ml normal saline at each trigger point, whereas Group A received 3ml of 0.25% Ropivacaine. Dry needling of trigger sites was done in both groups. Patients were assessed at two, four, and eight weeks of intervention. The patients' pre-treatment assessment measures showed no statistically significant differences. After 4 and 8 weeks of assessment, Group B NRS pain and BDI scores showed statistically significant improvements compared to pre-treatment results (p<0.05). NRS and BDI scores were reduced in group A compared to their pretreatment values, but that was not clinically significant. Results of our study showed that there was a statistically significant difference between both groups in terms of pain, stress, and anxiety after the intervention. Ropivacaine with methylprednisolone gave better results than Ropivacaine alone in reducing pain and anxiety among the study population.

COMPARISON OF THE VARIABILITY OF RECOVERY PROFILE AND HEMODYNAMIC EFFECTS OF NEUROMUSCULAR BLOCKADE WITH CISATRACURIUM VERSUS ATRACURIUM

A SIDDIQUI, S RAZA, S SHAFQAT, S ZEHRA, S BOZDAR, MN MUNIR — Tue, 19 Mar 2024 00:00:00 +0000

A randomized controlled trial was conducted at the Main Operation Theatre of Jinnah Postgraduate Medical Centre (JPMC) in Karachi to compare the recovery profile and hemodynamic effects of cisatracurium and atracurium among patients undergoing laparoscopic cholecystectomy. The study was conducted from 20th July 2019 to 19th January 2020 and included 68 patients aged between 20 to 50 years undergoing elective laparoscopic cholecystectomy under general anesthesia. Patients with a history of allergy to the study drugs, neuromuscular, pulmonary, renal, or hepatic diseases, smoking, pregnancy, or breastfeeding, and those on preoperative medication such as antipsychotics, aminoglycosides, steroids, or neuroleptics were excluded. The patients were randomly divided into two groups. In Group 1, comprising 34 patients, cisatracurium (0.2 mg/kg) was administered, whereas in Group 2, also with 34 patients, atracurium (0.5 mg/kg) was given. Neuromuscular blocking agents were administered three minutes before intubation. The primary outcomes measured were the recovery profile and hemodynamic effects. In Group 1 (cisatracurium), the baseline mean arterial pressure (MAP) was recorded as 98.40 ± 8.02 mmHg, which increased to 112.20 ± 8.88 mmHg before intubation, resulting in a change of 13.56 ± 5.59 mmHg. In contrast, in Group 2 (atracurium), the baseline MAP was 94.10 ± 7.91 mmHg, which rose to 109.07 ± 8.35 mmHg before intubation, indicating a change of 16.50 ± 4.38 mmHg. The study concluded that cisatracurium is more effective in exhibiting neuromuscular blocking properties than atracurium in patients undergoing laparoscopic cholecystectomy under general anesthesia.

CORRELATION OF EPICARDIAL FAT THICKNESS AND SEVERITY OF CORONARY ARTERY DISEASE AS ASSESSED BY SYNTAX SCORE ON CORONARY ANGIOGRAPHY

N ALI , M IRFAN , AU HASSAN , F GOHAR , N NAZEER — Sat, 10 Feb 2024 00:00:00 +0000

This study aimed to investigate the correlation between epicardial fat thickness and the severity of coronary artery disease (CAD) as assessed by the Syntax score on coronary angiography. A total of 50 patients with stable ischemic heart disease and uncontrolled anginal symptoms, presenting at the Cardiac Centre, Bahawal Victoria Hospital, Bahawalpur, were included in this study. These patients underwent coronary angiography, and those diagnosed with CAD were enrolled. Trans-thoracic echocardiography was performed to measure epicardial fat thickness. CAD severity was quantified using the Syntax score. Demographic data and other relevant variables were recorded in a pre-designed proforma, and data analysis was carried out using SPSS. The mean age of the study population was 51.2±9.05 years, with 54% of the participants being female. The study revealed a positive correlation between epicardial adipose tissue and the severity of CAD as assessed by the Syntax score (r = 0.426, p-value 0.002). In conclusion, this study found a positive albeit weak correlation between epicardial fat thickness and the severity of CAD as determined by the Syntax score on coronary angiography. These findings provide valuable insights into the potential role of epicardial fat as a marker for CAD severity. Further research is warranted to explore this relationship in larger and more diverse patient populations and to establish its clinical implications.

ASSESSING KNOWLEDGE, ATTITUDE, AND PRACTICE OF HEALTHCARE WORKERS REGARDING MEDICAL WASTE MANAGEMENT AT DISTRICT JAMSHORO, SINDH

AH BHACHO, HB CHANNAR , T AKHTAR, A AHMED, F SIYAL, . IQRA — Mon, 04 Mar 2024 00:00:00 +0000

This study aimed to evaluate the waste management knowledge, attitudes, and practices of three groups of healthcare workers: doctors, nurses, and paramedical staff. A cross-sectional study involved doctors, nurses, and technicians at the National Institute of Cardiovascular Disease (NICVD) and the Syed Abdullah Shah Institute of Medical and Health Science (SASIMS) in Shahwan Sharif, District Jamshoro, Sindh. A convenient non-probability sampling technique was used to select the study participants. A total of 370 healthcare workers consented to be part of the study. The data was obtained through the administration of questionnaires. Data were collected and compiled using Microsoft Excel and analyzed using SPSS version 22.0. This study had 39 (63.2%) males and 34 (36.8 %%) females. The median age of participants was 30.5 years, with a mean of 33.12 ± 8.2 years. The majority of the participants were paramedics (42.7%). They were followed by doctors (34.3%) and nurses (23%). The knowledge of healthcare workers indicated that there was a significant association between the waste categories (p = 0.02), type of waste (p = 0.00), color coding differentiation (p = 0.01), hospital policies (p = 0.00), infection control department (p = 0.03), risk toward healthcare workers (p = 0.00), human anatomical waste (p = 0.01), color-coding container used for wasted sharps and infectious solid waste (p = 0.00), and type of color-coding container (p = 0.00) This study highlights the discrepancies and inadequacies of knowledge and practice of proper healthcare waste management among healthcare workers. Healthcare workers with adequate knowledge were paramedics, doctors, and nurses. All healthcare personnel should have medical waste management guidelines ready and easily accessible.

BREAST ABSCESSES REQUIRING REPEAT INTERVENTIONS AND THEIR ASSOCIATED RISK FACTORS: A PROSPECTIVE, SINGLE CENTRED STUDY

B JAWAID , F ZAHEER , H SHAHAB , . KOMAL, S SALMAN , B SHAKEEL — Fri, 12 Jan 2024 00:00:00 +0000

The primary objective of the present study was to identify the frequency of breast abscesses requiring repeated intervention and to determine the risk factors associated with breast abscesses requiring repeated intervention. This observational study was conducted at surgical unit 5, Dr. Ruth K. M. Pfau Civil Hospital Karachi from January 2023 to June 2023. Patients’ demographics and other study-related information were recorded in the predesigned study performa. Afterward, the patient’s baseline blood workup was sent, and an ultrasound of the abscess was performed. Incision and drainage of the breast abscess were performed under general anesthesia by a year 4 general surgery resident. he average age of the 169 participants was 35 years with an average BMI of 25kg/m2. The average days observed for presenting the symptoms in study participants were 8 days. In the present study, 55.6% were lactating participants, 28.4% had diabetes, 16.6% were smokers, 11.8% had hypotension, 4.7% had ischemic heart disease, and 4.1% were pregnant. One incision and drainage needed participants (n=135), and repeated incision and drainage needed participants (n=34). 20% of our patients underwent repeated Incision and Drainage for breast abscess, where statistically significant risk factors included advancing age, diabetes, and smoking. In conclusion, our research shows patients with advancing age, diabetes and history of smoking should be given paramount focus when treating breast abscess as they have higher chances of failed treatment with incision and drainage and disease recurrence.

COMPLICATIONS ASSOCIATED WITH INTERNAL ILIAC LIGATION IN THE CONTEXT OF SEVERE POST-PERIPARTUM HYSTERECTOMY BLEEDING

S ULLAH , Q QAZI , N KHAN , H KHAN , N SHAHBAZ — Tue, 26 Mar 2024 00:00:00 +0000

Severe post-peripartum hysterectomy bleeding poses a critical threat to maternal health, necessitating swift and effective interventions to ensure favorable outcomes. The main objective of the study is to find the potential complications associated with internal iliac ligation in the context of severe post-peripartum hysterectomy bleeding. This prospective observational study was conducted in the gynecology and obstetrics department of Lady Reading Hospital Peshawar from June 2022 til the required sample size is obtained. The study included women who had significant and profuse post-peripartum hysterectomy bleeding. All women with post-peripartum hysterectomy hemorrhage were identified, focusing specifically on cases where internal iliac ligation was employed as an intervention. The demographic information, including patient age, parity, medical history, and obstetric details, was collected on predesigned proforma. Data was collected from 196 patients. The mean age of the patients was 31.5±4.2 years. About 97% of patients were multiparas, and all patients presented with postpartum hemorrhage (100%). The mode of delivery was vaginal in 89% of cases. It is concluded that internal iliac ligation, while effective in controlling severe post-peripartum hysterectomy hemorrhage, presents a nuanced landscape marked by a low incidence of vascular (1.5%) and ureteric (0.5%) injuries. Consequently, we believe that procedure is worth try in the face of catastrophic uncontrolled haemorrhage, especially in low-income countries.

COMPARISON OF SURGICAL SITE INFECTION BETWEEN DIABETIC AND NON-DIABETIC PATIENTS IN CLEAN SURGICAL PROCEDURES

RA RAJA , MH ABBASI , MRU TAJ , . TALHA, T QAYYUM — Fri, 12 Apr 2024 00:00:00 +0000

Surgical site infections (SSIs) are a major concern in healthcare, especially for individuals with diabetes. Diabetes can impair wound healing and weaken the immune system, increasing the risk of SSIs. Studying SSIs in diabetic versus non-diabetic patients undergoing clean surgeries is vital for improving patient care. Objective: The primary objective of this study was to investigate the incidence of surgical site infections (SSIs) in individuals with diabetes compared to those without diabetes who underwent clean surgical procedures. Methods: After the ethical approval from the institutional review board, this comparative study was conducted at Combined Military Hospital Jhelum from July 2022 to December 2023. A consisted of people with diabetes (n=50), while Group B comprised patients who did not have diabetes (n=50). All patients were administered suitable antibiotics before surgery. Each patient received a singular intravenous dose of Ceftriaxone 1g, administered thirty minutes before initiating the initial incision. The patients were monitored for surgical site infections (SSI), defined as the presence of redness, fever, tenderness at the incision site, discharge from the surgical wound, or the development of an abscess within 28 days after surgery. Results: Most participants in both study groups underwent open ventral hernia repair procedures, 54% in group A and 58% in group B. Mean± S. D of the Hb1Ac levels of the participants in both groups was 8.46±1.16 and 4.14±1.01 (P=<0.0001). 58% of participants in Group A, while 22% in Group B had surgery-associated complications (p<0.0001). 30% of participants in Group A, while 10% in Group B had SSI (p<0.0001). Conclusion: Individuals with diabetes are more susceptible to experiencing higher rates of surgical site infection, especially in cases of procedures that are considered clean, in comparison to individuals without diabetes.

RED BLOOD CELL INDICES IN PATIENTS WITH CARDIOVASCULAR DISEASES AT A TERTIARY CARE HOSPITAL PESHAWAR

A KHAN , F GOHAR , J AHMAD , L HUMAYUN , A KHAN , AK REHMAN — Thu, 25 Jan 2024 00:00:00 +0000

Cardiovascular diseases are a major cause of health loss worldwide, regardless of a country's income, social status, or demographics. Many studies have reported a link between haematological parameters and cardiovascular diseases in patients. This study aimed to determine the red blood cell indices in patients with cardiovascular diseases at a tertiary care hospital in Peshawar. The study was conducted for six months, from January 1, 2023, to June 30, 2023, at the Pathology Department of Afridi Medical Complex and Teaching Hospital. Blood samples were taken from patients in EDTA vacutainers, and their haematological parameters were determined in the laboratory. The patients' clinical examinations, history, name, gender, age, and previous laboratory investigations were recorded in a proforma designed for this research. The data were analyzed using IBM SPSS version 23. The study enrolled 80 patients with cardiovascular diseases, including 44 (55%) male and 36 (45%) female patients. The mean age of the study participants was 47 years, with a standard deviation of ±12.3. The mean (±SD) haemoglobin, red blood cell count, hematocrit, mean corpuscular haemoglobin, red cell distribution width-SD, and red cell distribution width-CV were 13.99 (±1.86) (g/dl), 4.49 (±0.55) (million/cm3), 40.72 (±5.81), 28.99 (±2.22), 62.06 (±6.99), and 16.87 (±3.39), respectively. The study concludes that red blood cell indices such as red cell distribution width, haemoglobin, and mean corpuscular volume play a significant role in the pathogenesis of cardiovascular diseases. Routine health examinations and proactive precautions may help lower cardiovascular disease incidence.

FACTORS CONTRIBUTING TO HIGH RATES OF CEASERIAN SECTION

Z KHOSO, KN MEMON, HB CHANNAR, Z BHUTTO, R PARVEEN, MU SALAM, M BAQAR — Sun, 25 Feb 2024 00:00:00 +0000

The increasing rate of caesarean deliveries is a major concern for public health experts worldwide. A study was conducted from January to September 2022 at the civil hospital Khairpur Mir to determine the rates of C-sections compared to normal vaginal deliveries and to evaluate the factors contributing to their increased rate in women. The study included 354 pregnant women aged 20 to 40 years who were surveyed using a pre-tested, structured questionnaire. The data was then analysed using SPSS version 16. Out of the 354 participants, 129 (36.4%) were aged between 31 to 35 years, 211 (59.6%) were uneducated, and 174 (49.2%) belonged to the middle socio-economic status. Furthermore, 103 (42.9%) women delivered by C-section, while 71 (62.3%) had a normal delivery. 54 (15.3%) participants had a parity of three, of which 19 (7.9%) women delivered by C-section, and 35 (30.7%) delivered by normal vaginal delivery. The study found that factors such as maternal age, mother's education, pregnancy complications, utilization of antenatal care, place of birth, area of residence, wealth profiles of mothers, and the number of exercises performed in the last semester were all linked to C-section. The study shows that these factors were the major contributors and strongly associated with higher C-section rates than normal deliveries. Additionally, educational status, occupation, economic status parity, place of C-section, place of ANC visit, and number of ANC visits were also found to be linked to C-section. The p-value was found to be 0.05. In conclusion, this study highlights the need for increased awareness and education on the factors contributing to the high rate of C-section deliveries, and the importance of normal vaginal deliveries for the health and well-being of both mother and child.

FREQUENCY OF TORCH INFECTION AMONG CONGENITAL CATARACT PATIENTS

SA BHUTTO , AA ABRO , NA KATPAR , DD SHAIKH , SA ABBASI , PA GUL — Fri, 22 Mar 2024 00:00:00 +0000

The objective of this descriptive cross-sectional study was to determine the frequency of TORCH infections among congenital cataract patients. The study was conducted at Shaheed Mohtarma Benazir Bhutto Medical University Larkana, from September 22, 2021, to March 21, 2022. Patients meeting the inclusion criteria, including those diagnosed with congenital cataracts and TORCH infection within the age range of one day to ten years, were included after obtaining informed consent from their guardians. A slit lamp examination was performed to identify lens opacities indicative of congenital cataracts. Subsequently, patients with congenital cataracts were sent for laboratory investigation. TORCH infections were diagnosed based on IgM levels and clinical manifestations specific to each pathogen. The results revealed that the age range of the patients included in the study was one day to ten years, with a mean age of 17.9 ± 21.8 months. Of the 85 patients with congenital cataracts, 36 (42.5%) were male, and 49 (57.5%) were female. Interestingly, TORCH infection was identified in 17 (19.6%) patients with congenital cataracts, while the remaining patients showed no evidence of TORCH infection. In conclusion, TORCH pathogens, particularly cytomegalovirus and rubella virus, were found to be frequent causative agents of congenital cataracts. These findings highlight the importance of early diagnosis and management of TORCH infections in patients with congenital cataracts to prevent visual impairment and other associated complications.

EVALUATING THE IMPACT OF PRACTICAL EXPERIENCE ON CPR PROFICIENCY: A COMPARATIVE ANALYSIS

Wed, 10 Jan 2024 00:00:00 +0000

Cardiopulmonary Resuscitation (CPR) is a critical life-saving skill, especially in healthcare settings where timely and proficient intervention can significantly impact patient outcomes. While theoretical CPR training provides foundational knowledge, integrating practical experience is essential for bridging the gap between theoretical understanding and practical real-world application. The primary objectives include evaluating how practical experience influences CPR proficiency between individuals with theoretical training only and those with one year of practical (real-time) experience. The study aims to provide valuable insights into the effectiveness of CPR training programs and the significance of practical exposure in improving outcomes. Seventy healthcare professionals, comprising 35 doctors with CPR training only (Group A) and 35 doctors with one year of practical CPR experience (Group B), were subjected to standardized Basic Life Support (BLS) testing on a manikin. Various CPR performance indicators were meticulously assessed, such as compression depth, rate, hand positioning, effective ventilations, and hands-off time. Statistical analyses were conducted to draw comparisons and highlight the impact of practical experience. With practical experience, Group B demonstrated significantly superior CPR performance compared to Group A. This was evident in shorter start-up time, enhanced compression depth and hand positioning, higher rates of effective ventilations, and reduced hands-off time. While compression rates remained similar between the groups, practical experience emerged as a crucial factor influencing diverse CPR quality indicators. The study concludes that practical experience is pivotal in improving CPR proficiency, emphasizing the need for hands-on components in training programs. These findings contribute to refining CPR training strategies for enhanced real-world application and improved emergency survival rates. Ongoing research in this field is crucial for continuous advancements in CPR protocols.

COMPARISON OF LAPAROSCOPIC AND OPEN APPENDECTOMY IN TERMS OF SURGICAL SITE INFECTION

R ULLAH , M SHAH , Y BABAR , A KHAN — Sun, 04 Feb 2024 00:00:00 +0000

Appendectomy is a common surgical procedure, and the choice between laparoscopic and open approaches has clinical significance. Surgical site infection (SSI) is a critical postoperative complication. This study aimed to compare laparoscopic and open appendectomy in terms of SSI rates. A prospective observational study was conducted at multiple centers including Department of General Surgery, MRHSM Hospital Pabbi Nowshera, Jinnah Teaching Hospital Peshawar and Cat C Hospital Tangi Charsadda, DHQ Hospital Daggar Buner, Khyber Pakhtunkhwa Pakistan in the duration from July, 2023 to December, 2023. The research is involving 320 patients aged 14 to 64 years. Data included demographic information, surgical approach, operative time, hospital stay, and SSI severity using the Southampton grading system. Statistical analysis was performed using SPSS. Laparoscopic (Group A, n=110) and open (Group B, n=210) appendectomies were compared. Group A had a shorter hospital stay (p < 0.05) and similar operative times. SSI rates favored laparoscopic surgery (p < 0.05), with fewer patients developing infections within 10 days post-surgery. Laparoscopic appendectomy demonstrated reduced SSI risk and improved postoperative outcomes. Laparoscopic appendectomy is associated with lower SSI rates, shorter hospital stays, and comparable operative times compared to open appendectomy. These findings support the preference for laparoscopic surgery, especially in low-risk patients, to enhance postoperative outcomes.

IMPACT OF PUNCTUALITY AND REGULARITY ON LEARNING BEHAVIORS AND CLINICAL SKILLS IN POST-GRADUATE RESIDENTS AT NISHTAR HOSPITAL MULTAN

SM GILLANI , T SAJJAD , F TAYAB , MRQ RAO , MS RAO , F SHAMS — Sun, 10 Mar 2024 00:00:00 +0000

: Punctuality and regularity are crucial traits in medical education that can significantly impact learning behaviors and clinical skills development. However, there is a lack of empirical evidence investigating their impact on postgraduate residents in the Pakistani healthcare system. This qualitative study aims to explore the experiences and perceptions of doctoral residents regarding punctuality and regularity in their clinical and learning activities at Nishtar Hospital Multan. The study also seeks to identify the perceived effects of punctuality and regularity on residents' learning behaviors and clinical skills development, highlight any barriers or facilitators to maintaining punctuality and regularity in the residency program, and provide insights to inform future interventions or policies aimed at promoting punctuality and regularity among postgraduate residents. The study found that punctuality and regularity significantly enhance postgraduate residents' learning behaviors and clinical skills. Punctual and regular residents reported better time management skills, increased exposure to different cases, and improved academic performance in their clinical and learning activities. However, some residents faced barriers to maintaining punctuality and regularity, such as long working hours and inadequate supervisor support. The study suggests that interventions aimed at promoting punctuality and regularity should consider the unique challenges and opportunities of the Pakistani healthcare system and prioritize the needs and experiences of postgraduate residents.

ASSESSMENT OF ATTITUDES OF NURSING STAFF TOWARDS FEMALE OBESE PATIENTS

R GEORGE , S BASHIR , QU NISA — Wed, 10 Apr 2024 00:00:00 +0000

Obesity is a pervasive healthcare challenge impacting patient care and outcomes. Despite the crucial role of nurses in patient management, stigmatising attitudes towards obesity among nurses remain inadequately explored, particularly concerning female obese patients. Objective: This cross-sectional study aimed to assess nurses' stigmatising attitudes towards female obese patients and explore associated factors. Methods: The current study was conducted at Nishter Medical College and Hospital, Multan, from January 2022 to January 2023. It involved 100 nurses. A structured questionnaire gathered demographic data and utilised the Fat Phobia Scale (FPS) to gauge attitudes towards obesity. Data analysis employed descriptive and inferential statistics, including chi-square tests and regression analysis. Results: Predominantly female participants (70%) with a mean age of 32.5 years and an average experience of 8.2 years were included. The mean FPS score was 3.2, indicating moderate stigmatising attitudes towards obesity. Regression analysis revealed significant predictors of attitudes towards obesity, with years of experience and educational background playing key roles (p < 0.05). Conclusion: The findings underscore moderate levels of stigmatising attitudes towards female obese patients among nurses. Addressing these attitudes through targeted educational interventions and professional development initiatives holds promise for enhancing patient care and outcomes.

COMPARING THE EFFICACY OF 30 ML AND 60 ML FOLEY'S CATHETER BALLOON INFLATION FOR INDUCTION OF LABOR IN TERM SINGLETON MULTIGRAVIDA PATIENTS: A RANDOMIZED TRIAL

A SHAHZADI — Fri, 26 Jan 2024 00:00:00 +0000

Labour induction is a common obstetric technique, especially for term singleton multigravida patients. The Foley's catheter balloon inflation method is widely used, and the efficacy of this technique may be affected by differences in balloon capacity. Thus, this study aimed to compare the effectiveness of two balloon inflation volumes, 30 mL and 60 mL, for inducing labour in term singleton multigravida patients. This study was a prospective, randomized, parallel-group design conducted at Gajju Khan Medical College, Swabi, between September 2022 and September 2023 The study included 112-term singleton multigravida with a gestational age of 37 weeks or more, a single-fetus pregnancy, and prior pregnancies. Using computer-generated random numbers, participants were randomly assigned to Group A (30 mL) or Group B (60 mL). The results of the study showed that both groups had similar baseline characteristics. Group A had an average age of 28.5 years, while Group B had an average age of 29.2 years. Group A's mean gestational age was 39.1 weeks, while Group B's was 38.9 weeks. Patients in both groups were multiparous. The mean induction-to-delivery delay was 10.2 days for Group A and 12.8 days for Group B, with a statistically significant difference (p=0.034). After balloon inflation, Group A bishop scores improved from 4.2 to 7.8, and Group B bishop scores improved from 4.1 to 7.6 (p=0.498). The research shows that 60 mL of folleys catheter balloon inflation for cervical ripening in labour induction may shorten the induction-to-delivery period without compromising newborn outcomes.

A RETROSPECTIVE STUDY ON MATERNAL AND FETAL OUTCOMES ASSOCIATED WITH ASSISTED REPRODUCTIVE TECHNOLOGIES

W HAQ , F AWAN , S TAJ , DR ARSH, R BHITTANI — Sat, 17 Feb 2024 00:00:00 +0000

Assisted Reproductive Technologies (ART) have revolutionized the landscape of reproductive medicine, offering hope to couples facing infertility challenges. The study's main objective is to find the maternal and fetal outcomes associated with assisted reproductive technologies. This retrospective cohort study was conducted in Lady Reading Hospital Peshawar from July 2019 to June 2023. The study includes 850 participants who underwent ART procedures between 2021 and 2022. Details of the ART procedures, such as the technique employed, the number of embryos transferred, and the utilization of preimplantation genetic testing, were meticulously documented. Maternal outcomes were a focal point, with a comprehensive assessment of pregnancy-related hypertensive disorders, gestational diabetes, mode of delivery, and any postpartum complications. Data was collected from 850 participants. The mean maternal age was 33.5 years (SD = 4.2), and the mean BMI was 25.8 (SD = 3.5). The primary causes of infertility varied, with male factor infertility being the most prevalent at 40%, followed by ovulatory dysfunction at 30% and unexplained infertility at 20%. The ART procedures in the study cohort comprised In Vitro Fertilization (IVF) at 60%, followed by Intracytoplasmic Sperm Injection (ICSI) at 25%, and other ART techniques at 15%. Regarding the number of embryos transferred, the majority received a single source (70%), with 20% receiving two starts and 10% receiving three or more. It is concluded that pregnancies conceived through Assisted Reproductive Technologies (ART) exhibit a higher prevalence of pregnancy-related hypertensive disorders and gestational diabetes compared to naturally conceived pregnancies.

SEDATION DEPTH DURING CRITICAL CARE TRANSPORT AND HOSPITALIZATION

M HAROON, . SULAIMAN, MJ KHAN, IU HAQ, S AHMAD, S MALIK — Mon, 18 Mar 2024 00:00:00 +0000

The purpose of this study was to determine the differences in attained levels of sedation both within intensive care units and collectively regarding overall outcomes when patients were transported outside a hospital either pre-hospital or while being inter-facility transfer by different critical care agencies, having been exposed to light versus deep quality of anaesthesia. After the ethical approval from the institutional review board, this cross-sectional study was conducted at Khyber Teaching Hospital from 01/06/22 to 31/12/22. The primary outcome measure was the relation of starting deep sedation during transport to deep sedation in the first 48 hours after admission (defined as RASS -3 and less). Secondary outcomes included mechanical ventilation duration, inpatient mortality, total hospital stay length of ICU, and delirium within 48 h; coma may also be observed. Final transport RASS in both the study groups was-4.43±0.49 and-1.5±0.5 (p <0.0001). Mean Hospital duration in both study groups was 13.01±4.8 and 35±5.9 days (p<0.0001). A high percentage of inpatient mortality, delirium, and coma cases was seen in the deep sedation group (p<0.0001). The transfer of patient care from the transport team to the hospital team presents a chance to potentially interrupt the progress of treatment and reassess decisions regarding sedation.

EFFICACY OF HOLMIUM LASER (LL) WITH PNEUMATIC LITHOTRIPSY (PL) IN PATIENTS WITH PROXIMAL URETERAL STONES

WA MEMON , Z MALIK , R KUMAR , SF AHMED , MI SHAIKH , AR KHOWAJA — Sun, 31 Mar 2024 00:00:00 +0000

The present study aimed to compare the success rate of holmium laser (LL) with pneumatic lithotripsy (PL) in patients with proximal ureteral stones. A randomized controlled trial was carried out in the Department of Urology at the Liaquat National Hospital in Karachi between December 2020 and June 2021. Included were 124 patients who had ureteric stones in their proximal ureters. Pneumatic lithotripsy and holmium laser groups were created for the patients. The complete removal of the stones, as determined by kidney, ureter, and bladder computed tomography (CT-KUB), was the definition of the treatment's success. Stratification was carried out, and descriptive statistics were calculated. The post-stratification Chi-square test was used, and a P-value of less than 0.05 was deemed significant. The average length of time a stone was present was 10.54 ± 2.65 days in group A and 10.43 ± 2.68 days in group B. The average stone size in group A was 1.58 ± 0.22 cm, whereas in group B, it was 1.54 ± 0.22 cm. 93.5% of group A and 69.4% of group B were stone-free. The study groups showed a noteworthy correlation about their stone-free condition. For proximal ureteral stones with a size up to 2 cm, comparing pneumatic lithotripsy 1.9 to holmium laser, which has a higher success rate, is the recommended method.

MATERNAL AND FETAL OUTCOME OF PREGNANT PATIENTS GIVEN COVID-19 VACCINATION DURING ANTENATAL PERIOD

SA SABIR , S SULTAN — Tue, 02 Jan 2024 00:00:00 +0000

This study aimed to assess potential adverse maternal and fetal outcomes among pregnant women who received COVID-19 vaccination during pregnancy. The study was conducted at the Lady Reading Hospital, Peshawar, gynaecology OPD. It included 120 pregnant females aged 18-35 years with a gestational age of more than 32 weeks. Of the 120 participants, 60 received the COVID-19 vaccine during pregnancy, while 60 did not. The study aimed to determine whether there were any adverse outcomes, such as eclampsia/preeclampsia, fetal growth restriction, NICU admission, preterm birth, birth weight, and postpartum haemorrhage. The study found that 60% of the participants were vaccinated for COVID-19 during pregnancy, while 60% did not receive the vaccine. Both cohorts showed no significant difference in terms of adverse outcomes such as eclampsia/preeclampsia, fetal growth restriction, NICU admission, preterm birth, birth weight, and postpartum haemorrhage. No significant difference was found in fetomaternal outcomes between the two groups. Pregnant females who received the COVID-19 vaccine during pregnancy did not experience any significant adverse outcomes such as eclampsia/preeclampsia, fetal growth restriction, NICU admission, preterm birth, birth weight, and postpartum haemorrhage.

TRANSULNAR TECHNIQUE AMONG PATIENTS UNDERGONE PERCUTANEOUS CORONARY INTERVENTIONS: A STUDY ON ASSOCIATED COMPLICATIONS

T NAWAZ, S HUSSAIN, M AMIN, H ALI, W SAJJAD — Thu, 01 Feb 2024 00:00:00 +0000

The objective of this observational study, conducted at the Department of Cardiology in LRH, Peshawar from June 2023 to December 2023, was to assess the complications associated with the transulnar technique in patients undergoing percutaneous coronary interventions (PCI) for ischemic heart disease. A total of 110 patients were included in this study. All patients underwent PCI with the transulnar technique, and complications were assessed post-procedure. The mean age of the patients was 58.75±7.05. The complications observed were minor bleeding in 20 patients (18.2%), ulnar artery occlusion in 9 patients (8.2%), hematoma in 6 patients (5.5%), and stroke in 2 patients (1.8%). The transulnar technique is an effective modality for patients undergoing PCI in terms of complications such as minor bleeding, ulnar artery occlusion, hematoma, and stroke.

EFFECTS OF A KETOGENIC DIET IN OVERWEIGHT WOMEN WITH POLYCYSTIC OVARY SYNDROME

A NAVEED , A SAYYEDA , SA MEMON , Z BHUTTO — Tue, 12 Mar 2024 00:00:00 +0000

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive-aged women, characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. The main objective of the study is to find the effects of a ketogenic diet in overweight women with polycystic ovary syndrome. This prospective interventional study was conducted in a private hospital in Karachi, Pakistan, from June 2023 to Dec 2023. Data was collected from 320 females who were suffering from PCOS. Participants were randomized into two groups: the intervention group (n = 160) received a ketogenic diet, while the control group (n = 160) followed a standard hypocaloric diet. Randomization was performed using computer-generated random numbers to ensure allocation concealment and minimize selection bias. Upon enrollment, participants underwent baseline evaluations to establish their demographic characteristics, medical history, and anthropometric measurements, including weight, BMI, and waist circumference. Data were collected from 320 female patients. In the ketogenic diet (KD) group, participants had a mean age of 28.1±4.2 years and a mean BMI of 30.01±2.3 kg/m2. Their waist circumference averaged 90.1±5.0cm, with a fasting glucose level of 110±10 mg/dL and a DHEAS level of 350±50 μg/dL. In the ketogenic diet (KD) group, participants experienced a mean reduction in body weight of 8.5±2.3kg, a decrease in BMI of 3.2±1.1Kg/m2, and a reduction in waist circumference of 10±4cm. Conversely, the control group exhibited a mean decrease in body weight of 2.5±1.5kg, a reduction in BMI of 1.0±0.8kg/m2, and a decrease in waist circumference of 3±2cm. It is concluded that the ketogenic diet may offer metabolic and reproductive benefits for overweight women with polycystic ovary syndrome. The improvements observed in metabolic parameters and menstrual regularity support the potential role of KD as a therapeutic intervention in PCOS management.

FREQUENCY OF THROMBOCYTOPENIA AMONG PATIENTS WITH CIRRHOSIS

. MAAZ, A HAMEED , S SHAH , N MAZARI , Y SHABBIR — Wed, 17 Apr 2024 00:00:00 +0000

Thrombocytopenia is a frequently observed condition in individuals suffering from liver cirrhosis. Objective: To find out the frequency of thrombocytopenia in patients with cirrhosis. Methodology: This cross-sectional study was conducted in the Department of Medicine, Khyber Teaching Hospital, Peshawar, from January 2022 to January 2023. All patients with cirrhosis of duration > six months, with ages of 18-60 years, both genders, and any grade of cirrhosis severity were included in the study. Patients with diseases like malaria, dengue fever, ITP and haematological malignancy, SLE, leukaemia, aplastic anaemia, or on drugs like quinine, penicillin, and digoxin were excluded from the study. Platelet counts were done by sending blood to the hospital laboratory. Result: Mean age was 47.43 ± 6.22 years, mean BMI was 25.29 ± 4.06 kg/m2, and mean disease duration was 14.86 ± 5.36 years. Males were 75 (53.1%), and females were 67 (46.9%). Thrombocytopenia was present in 108 (75.5%) and not in 35 (24.5%) patients. There was no association of age, gender, or Child-Pugh score with the occurrence of thrombocytopenia. Still, the increased BMI and increased disease duration were significantly associated with thrombocytopenia (p-value <0.05). Conclusion: There is quite a high prevalence of thrombocytopenia in patients with liver cirrhosis. The duration of the disease and increased BMI are significantly associated with the occurrence of thrombocytopenia. Further studies are recommended to have further proof.

FREQUENCY OF SPONTANEOUS MISCARRIAGES IN OBESE AND NON-OBESE WOMEN

A UROOJ , SA KHAN , F AWAN — Fri, 19 Jan 2024 00:00:00 +0000

Miscarriages are a common complication of pregnancy, affecting approximately 12-15% of all clinically recognized pregnancies in the general population. However, the exact frequency of miscarriages is unknown as they often occur before a woman is aware of her pregnancy. The main objective of this study was to determine the frequency of spontaneous miscarriages in pregnant women and to compare the frequency between obese and non-obese women. This cross-sectional study was conducted in the Gynecology Department of Lady Reading Hospital in Peshawar from November 16, 2019, to November 16, 2020. During this study, 140 patients were observed, and dates calculated their gestation period. A P/V examination was conducted, and a TVS or Pelvic ultrasound was performed to confirm the diagnosis of spontaneous miscarriage. Informed consent was obtained after the diagnosis, and data was collected using an attached Performa. The mean age of the patients in this study was 29 years, with a standard deviation of ± 7.714. Forty-one percent of the patients were primigravida, while 59% were multigravida. The study revealed that the frequency of spontaneous miscarriages was 12% among pregnant women. Furthermore, the incidence of spontaneous miscarriages was more common in obese pregnant women compared to non-obese pregnant women.

PREVALENCE AND ANTIBIOTIC SUSCEPTIBILITY PATTERN OF GRAM NEGATIVE BACILLI ISOLATED FROM URINARY TRACT INFECTIONS

JA KHAN , K QAMAR , F GOHAR , J AHMAD , S BANO , K FAROOQ — Sun, 18 Feb 2024 00:00:00 +0000

The aim of the study was to find out the prevalence and antibiotic susceptibility pattern of Gram negative bacilli isolated from urinary tract infections. This cross-sectional study was conducted at the department of urology Lady reading hospital Peshawar from February 2021 to August 2023. Mid-stream urine samples were collected from individual having the symptoms of urinary tract infection and were processed and identified through various biochemical tests. Following CLSI recommendations, the isolated bacteria were screened for sensitivity to antibiotics. Kirby-Bauer disc diffusion method was used in the current study. Through MS Excel, data were analyzed. The Chi-square test was applied for calculating the p value (significant i.e. <0.05) and antibiotic resistant profiles of GNB isolated from urine samples. A total of 60000 urine samples were collected in which 65% (n=3900) patients were outdoor and 35% (n=2100) were hospitalized patients. Among them 20 % (n=1200) were culture positive. Among which 58% urine samples were from outdoor patients and 42% samples were from hospitalized patients. E.coli, Klebsiella pneumonia, P. aeruginosa and Acinetobacter baumannii were the Gram negative bacilli (GNB) isolated in our study. The most prevalent (72%) GNB was E. coli. Pseudomonas aeruginosa isolated from indoor patients’ urine samples showed high resistance. The antibiotic sensitivity pattern of K. Pneumonia was same as E.coli both in out and indoor patients. The .Acinetobacter baumannii resistance pattern was quite lower observed as 85% in Nitrofurantoin (F), 80% in Ampicillin (AMP) and 11% in Fosfomycin (FOS) respectively in urine samples of indoor as compare to outdoor patient. The most prevalent GNB observed in our study were E. coli, Klebsiella pneumonia, P. aeruginosa and Acinetobacter baumannii involved in UTIS. The choice of antibiotic for its treatment were Fosfomycin, Piperacillintazobactam, Cefoperazone-sulbactam, Amikacin and Nitrofurantoin.

THE ANATOMY OF BONE HEALING: BONE REGENERATION IN ORTHOPEDIC MEDICINE

QUA KHAN, F MALIK, SAZ NAQVI, T KAUSAR, T RAZA, A MANSOOR — Mon, 18 Mar 2024 00:00:00 +0000

Bone regeneration is a physiological bone formation process involved in routine fracture healing and continuous remodeling throughout adult life. The study's main objective is to determine the role of orthopedic medicines in bone regeneration and healing process. This retrospective study was conducted in a public hospital in Karachi, Pakistan, from February 2023 to June 2023. The study aimed to collect data from 120 bone fracture patients and evaluate the progression of bone healing to identify critical determinants of successful regeneration. Clinical assessments, radiological imaging, and histopathological analyses were conducted to achieve the study's objectives. The study collected data from 120 patients, with a mean age of 45.21±12.3 years. Of these, 70 were male and 50 were female. Upper extremities accounted for 40% of fractures, lower extremities 30%, and axial skeleton 30%. Simple fractures accounted for 50% of cases, while comminuted fractures represented 30% and open fractures 20%. There was a strong positive correlation between fracture severity and the time required for radiographic union, with a correlation coefficient (r) of 0.65 (p < 0.001). Additionally, biomarkers of bone turnover exhibited a moderate positive correlation with radiological healing, with a correlation coefficient (r) of 0.45 (p = 0.003). The study concludes that orthopedic interventions have a high success rate in achieving satisfactory outcomes, with the majority of patients experiencing successful bone healing and restoration of function.

POWER OF NURSING EDUCATION TO INFLUENCE THE ATTRIBUTES OF STUDENTS IN A PRIVATE COLLEGE OF NURSING

K RASHEED , M ZAFAR , B FARID , B RASHEED , H ARSHAD — Sun, 31 Mar 2024 00:00:00 +0000

This methodological study addresses a critical gap in the research landscape by exploring the influence of nursing education on the attributes of nursing students in Pakistan. Despite existing studies in countries such as Iran, Egypt, and Finland, satisfactory research on this topic remains elusive. The study aims to develop and validate an instrument tailored for the Pakistani context, specifically focusing on the power of nursing education and its capacity to shape nursing students' attributes. A questionnaire-based approach was employed to gather data, focusing on the extent to which nursing education influences the attributes of student nurses. The analysis of the data revealed encouraging findings regarding the impact of nursing education on various attributes. Notably, improvements were observed in areas such as professional communication, fluidity, and the integration of human values and professional excellence into nursing practice. This study sheds light on the nuanced concept of the power of nursing education from the perspective of nursing professionals. The findings underscore the complexity inherent in this concept, emphasizing its significance within the context of the nursing profession's ethos of compassion, ethics, and care. Importantly, the study highlights the notion of professional influence through nursing education as a valuable concept, vital for fostering the professional growth and development of nursing students. Crucially, the results demonstrate that nursing education plays a pivotal role in enhancing nursing students' professional knowledge and overall development, thereby positively impacting their attributes. By equipping students with the necessary skills and knowledge, nursing education cultivates professionalism and establishes a strong foundation for future nursing practice. This study contributes to the international discourse on nursing education and underscores the importance of tailored research initiatives to understand its impact on nursing students' attributes across diverse cultural and contextual settings.

ASSESSING IRON DEFICIENCY AS RISK FACTOR FOR FEBRILE SEIZURES IN CHILDREN BETWEEN SIX MONTHS AND FIVE YEARS OF AGE

U SYED , F IKRAM , R NAWAZ , S NAWAZ , S TABUSSAM , S ZAMIR — Wed, 28 Feb 2024 00:00:00 +0000

This case-control study was conducted from September 2023 to December 2023 at the Department of Pediatrics in Pak Emirates Military Hospital, Rawalpindi. The study aimed to determine the relationship between iron deficiency and the development of febrile seizures in children. A total of 150 patients aged between 1 and 6 years, with a history of febrile seizures and currently suffering from pyrexia, were included in the study. Children with a history of recent febrile seizures, structural/organic brain lesions, congenital metabolic/chromosomal anomalies, non-febrile seizures, delayed milestones, or those who were on medications that altered serum iron levels within the past six months were excluded. All participants were assessed for serum iron, ferritin, total iron binding capacity, magnesium, zinc, and calcium at enrollment. Patients were observed for the development of febrile seizures until they were afebrile for twenty-four continuous hours. Of the total sample, the mean age was 3.41 ± 1.51 years, and 83 (55.3%) were male. Patients with a transferrin saturation below 6.5% had a higher adjusted odds ratio (aOR) of 3.96 (CI 95% 1.29 – 12.18, p=0.016) for developing febrile seizures during a pyrexial illness. Similarly, patients with hypozincaemia, defined as a serum zinc level <65 μg/dL, had an aOR of 2.54 (CI 95% 1.13 – 5.67, p=0.023). The study concluded that low serum levels of iron were associated with a higher risk of developing febrile seizures in pyrexial children with a history of the disorder.

INCIDENCE OF POST TRAUMATIC HYDROCEPHALUS IN PATIENTS UNDERGOING DECOMPRESSIVE CRANIECTOMY

U MATEEN , MM JUMMANI , S SHAUKAT , T BHATTI , . ZULQARNAIN, K FATIMA , AA KHAN — Sun, 07 Apr 2024 00:00:00 +0000

Decompressive craniectomy is a surgical procedure often employed in traumatic brain injury cases to alleviate intracranial pressure. Post-traumatic hydrocephalus, though a rare complication, can occur following this procedure, significantly impacting patient outcomes. Objective: This study aimed to investigate the incidence of post-traumatic hydrocephalus in patients undergoing decompressive craniectomy. Methods: A prospective cross-sectional study was conducted at the Emergency and Neurosurgery Department of Shaheed Mohtarma Benazir Bhutto Trauma Centre (SMBBIT) from June 1, 2022, to December 30, 2022. Demographic and clinical data were collected, including age, gender, Glasgow Coma Scale (GCS) at presentation and time of decompressive craniectomy, type of craniectomy, development of postoperative hydrocephalus, and complications. Results: The majority of patients (55%) were aged 10-15, with males comprising 75% of the cohort. Upon emergency presentation, only 4% of patients exhibited hydrocephalus, with most presenting a GCS between 9 and 13 (56%). Post-craniectomy, hydrocephalus developed in 32% of individuals, with the majority (18%) experiencing onset after 14 days. Significant associations were found between hydrocephalus development and craniectomy size (p=0.04) and distance from the midline (p=0.05). Conclusion: Patients undergoing decompressive craniectomy, particularly those with a superior limit too close to the midline, may be at risk of developing hydrocephalus. Therefore, we advocate for broader craniectomies exceeding 25 mm from the midline to potentially reduce the incidence of post-traumatic hydrocephalus and improve patient outcomes.

AWARENESS AND KNOWLEDGE OF VIRAL HEPATITIS PREVENTION AND TRANSMISSION IN HEALTHCARE WORKERS

MF JAMIL , AMI KHAN , N YOUSAF , HDA KHAN , K MALIK , S YOUSAF — Sat, 20 Jan 2024 00:00:00 +0000

The objective of this study was to evaluate the knowledge and awareness of healthcare workers about the prevention and transmission of hepatitis B virus. The study was conducted in Nishtar Medical Hospital, Multan, from January 2023 to September 2023 and included 300 healthcare workers, such as doctors and nurses. The participants were asked to fill out a 50-question questionnaire designed to test their knowledge about hepatitis B. The questionnaire was in English, but assistance was provided if needed. The questions were related to the virus, behaviors, and medical practices when treating infected patients, and it took an average of 30 minutes to complete. The results showed that 74% of the healthcare workers knew the consequences and possible complications of acquiring HBV infection. Between 69% and 80% of the respondents answered correctly about the transmission routes. However, only 24% of the HCWs knew the age distribution of the infections and that neonates were at the highest risk of developing it through mother-to-child transmission. Respondents answered wrongly about transmission through food and cutlery with the infected (69%), through sneezing and coughing (81%), prevention of infection by thorough cleaning (50%), and not sharing food and cutlery with the infected (55%). Only half of the workers knew about disposing of needles and syringes correctly. The average knowledge score was 24 ± 5 with a median score of 24 (10-33). Respondents performed the worst when answering questions about CHB monitoring and treatment. In conclusion, this study found that the awareness and knowledge about hepatitis B prevention and transmission among healthcare workers in Pakistan is poor. Therefore, it is recommended to make training programs mandatory for professionals to improve disease management.

ASSOCIATION OF LOW BMI AND ANOVULATION WITH PRIMARY INFERTILITY IN WOMEN OF REPRODUCTIVE AGE

H GUL , S SABIR , N SADIQ , R BIBI , FA KHAN , R AHMAD , H HIDAYAT — Sat, 17 Feb 2024 00:00:00 +0000

Infertility, defined as the inability to conceive after one year of regular unprotected intercourse, affects millions of couples worldwide, with prevalence rates varying across developed and developing nations. The main objective of the study is to find the association between low BMI and anovulation with primary infertility in women of reproductive age. This cross-sectional study was conducted in Khyber Teaching Hospital Peshawar from January 2023 to December 2023. A total of 340 female participants were added using convenient sampling methods. Data collection consisted of comprehensive clinical evaluations, including anthropometric measurements to assess BMI, hormonal assays to determine ovulatory status and detailed reproductive histories. BMI was calculated as weight in kilograms divided by height in meters squared (kg/m^2), with participants categorized into low BMI (BMI < 18.5 kg/m^2) and normal BMI (BMI ≥ 18.5 kg/m^2) groups. Data were collected from 340 female participants. The mean age was 28.5± 4.2 years for those with low BMI and 30.1± 3.8 years for those with normal BMI. Among underweight individuals, 50 were classified as infertile and 20 as fertile, totaling 70 participants. Of normal-weight individuals, 40 were infertile, and 120 were fertile, totaling 160 participants. In the overweight group, 30 were barren, and 50 were fertile, totaling 80 participants. Low BMI showed a significantly increased adjusted odds ratio (AOR) of 3.00 (95% CI: 1.80 - 5.00, p < 0.001) for infertility. Age, socioeconomic status, smoking, and alcohol consumption did not show significant associations with infertility. It is concluded that low BMI is significantly associated with an increased risk of anovulation and primary infertility in women of reproductive age, even after accounting for potential confounders.

COMPARISON OF THE EFFICACY OF INTRALESIONAL 5% FU VERSUS INTRALESIONAL TRIAMCINOLONE IN PATIENTS PRESENTING WITH KELOID AND HYPERTROPHIC SCAR AT TERTIARY CARE HOSPITAL, KARACHI

B SHAH , R GHAFOOR , N ASAD , A SAMEE , M SURHIYO , A SATTAR — Thu, 14 Mar 2024 00:00:00 +0000

Despite the fact that keloids and hypertrophic scars are frequent benign hyper-proliferative growths of dermal fibroblasts, the clinical concerns, such as physical and psychological issues, are serious and impairing, and there are few effective therapies. Although 5-fluorouracil (5-FU) and intralesional triamcinolone acetonide (TAC) are widely used to manage both scars, their effectiveness is still debatable. To compare the efficacy of intralesional 5% FU versus intralesional triamcinolone in patients presenting with keloid and hypertrophic scar at Tertiary Care Hospital, Karachi. This RCT study was conducted on patients presenting with keloid and hypertrophic scars at the Outpatient Department of Dermatology, JPMC, Karachi, meeting inclusion criteria. A brief history of demographic information and written informed consent were taken from each patient. A total of 158 patients were enrolled in the study and were randomly allocated to Group A, Intralesional triamcinolone group, and B: Intralesional 5% FU group twice weekly for a total of 4 sessions. During each visit, the keloid height was measured, photographed again, and documented. Efficacy was labeled if patients with keloid and hypertrophic scar in either group showed ≥ 50% reduction in height. Comparison of efficacy between groups showed a significant difference as the efficacy rate was higher in patients treated with 5-FU 45mg as compared to the patients administrated with TAC 10mg (70.9% vs. 50.6%; P-value=0.009). This analysis revealed that irrespective of the patient's age, sex, illness duration, or lesion site, intra-lesional 5-fluorouracil (5-FU) offered the significant benefit of a faster and more effective response than triamcinolone (TAC) in the treatment of keloids and hypertrophic scars.

FREQUENCY OF CYSTOID MACULAR EDEMA ON OPTICAL COHERENCE TOMOGRAPHY IN TWO DIFFERENT TYPES OF CATARACT SURGERY

MS KAMRAN , W AHMAD , MK KAMRAN , M AHMAD — Tue, 26 Mar 2024 00:00:00 +0000

Cystoid macular edema (CME), also known as Irvine-Gass syndrome, has been recognized as a non-specific manifestation of various ocular conditions, with cataract surgery being a significant contributing factor. First reported by Sir Irvine in 1953 and further discussed by Sir Norton in 1966, CME following cataract surgery remains a topic of interest and concern in ophthalmology. The precise etiology of CME in post-cataract surgery patients remains elusive; however, it is widely accepted that post-surgical inflammation plays a pivotal role. To address this issue, we conducted a comparative study to assess the frequency of CME using spectral-domain optical coherence tomography (SD-OCT) in patients undergoing extracapsular cataract extraction (ECCE) versus phacoemulsification cataract surgeries. The study was conducted at the Department of Clinical Ophthalmology, Khyber Institute of Ophthalmic Medical Sciences; Medical Teaching Institute Hayatabad Medical Complex, Peshawar, over a period of 6 months. Utilizing a randomized controlled trial design and non-probability consecutive sampling, we determined a sample size of 70 patients, with 35 patients allocated to each group (Group A: ECCE, Group B: Phacoemulsification). The age of the participants ranged from 50 to 85 years, with a median of 60 years and a mean of 65±8 years. Our findings revealed that CME was observed in 11% of patients in Group A and 6% in Group B, indicating a lower frequency in post-operative cases. However, the difference in CME incidence between ECCE and phacoemulsification cases was not statistically significant. These results suggest that the risk of CME in post-operative cases may be influenced by various factors, including surgical technique and patient-specific variables. In conclusion, our study contributes to the understanding of CME following cataract surgery and underscores the importance of continued vigilance and further research in this area. Improved surgical techniques and perioperative management may help mitigate the risk of CME and enhance patient outcomes in the postoperative period.

PATTERN OF CHRONIC LIVER DISEASE IN CHILDREN IN A TERTIARY CARE HOSPITAL

U SYED , F IKRAM , S NAWAZ , R NAWAZ , . SANA, S ZAMIR — Mon, 25 Mar 2024 00:00:00 +0000

The study aimed to identify the different signs, symptoms, and causes of chronic liver disease in children. The study involved patients between the ages of 1 and 12 years who were suspected of having chronic liver disease, excluding those with acute liver disease, congenital anomalies, and liver transplant recipients. The study was conducted in the Department of Pediatrics at Pak Emirates Military Hospital in Rawalpindi from September 2023 to December 2023. The results of the study showed that the most common causes of chronic liver disease in the patients were progressive familial intrahepatic cholestasis, followed by glycogen storage diseases, Hepatitis C, Wilson's disease, and Hepatitis B. Jaundice, abdominal distension, peripheral swelling, ascites, hepatomegaly, and splenomegaly were the most common symptoms of chronic liver disease. Some patients also suffered from variceal bleeding and hepatic encephalopathy. In conclusion, the study found that chronic liver disease in children from Pakistan has a diverse range of causes and symptoms.

ASSESSMENT OF LONG-TERM OUTCOMES OF PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION (PCI) FOR CHRONIC TOTAL OCCLUSIONS

K ASLAM, E IQBAL, MS KHAN, FR KHAN, W SAJJAD — Fri, 01 Mar 2024 00:00:00 +0000

A minimal surgical procedure called ‘PCI’ (percutaneous coronary intervention) is performed to treat those who have diseases of the coronary arteries. A period of more than three months of entire blockage of a coronary artery results in a ‘CTO’ (chronic total occlusions). The primary goal of the research is to determine the performance of patients who have ‘PCI’ (percutaneous coronary intervention) for chronic total occlusions (CTO). The study was conducted at Lady Reading Hospital MTI from March 2022 to December 2022. The research included 400 individuals with ‘percutaneous coronary intervention’ for ‘CTO.’ Information was gathered via follow-up appointments and records from patients. All-caused death was the study's primary objective; major adverse cardiac events (MACE), repeated revascularization’, and standard of life were its additional objectives. Survival analysis and descriptive statistical methods were used to analyze the data. This research looked at the long-term results of individuals who had ‘percutaneous coronary intervention ‘for ‘A CTO’ and revealed that 400 individuals had at least one ‘percutaneous coronary intervention ‘for a ‘CTO.’ The individual's average age was 58.9 ± 6.07 years, and 70.3% of them were men. This research concludes that with a total success rate of 87.5%, ‘percutaneous coronary intervention ‘for chronic complete occlusions may result in favorable long-lasting results.

COMPARISON OF TRANSTHORACIC AND TRANS-ESOPHAGEAL ECHOCARDIOGRAPHY IN THE DETECTION OF CARDIAC EMBOLI IN AFIB PATIENTS

H PASHA , U SUBHAN , M SALIM — Mon, 08 Apr 2024 00:00:00 +0000

Atrial fibrillation (AFib) predisposes patients to an increased risk of thromboembolic events, including stroke, due to the formation of cardiac emboli. Transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) are commonly used to detect cardiac emboli in AFib patients, but their comparative effectiveness remains unclear. Objective: This study aimed to compare the diagnostic accuracy of TTE and TEE in detecting cardiac emboli in AFib patients. Methods: A prospective observational study was conducted at the Shifa International Hospital in Islamabad, Pakistan, from January 2022 to January 2023. The study included 100 adult patients diagnosed with AFib, undergoing evaluation for suspected cardiac emboli. Both TTE and TEE examinations were performed as part of routine clinical care. Diagnostic accuracy parameters were calculated for both modalities using standard formulas, and comparative analyses were conducted using appropriate statistical tests. SPSS version 25 was used, and a P value less than 0.05 is considered statistically significant. Results: The study included 100 patients with atrial fibrillation (AFib), of which 55 were male, and 45 were female. The mean age of the patients was 65 years (standard deviation [SD] ± 7 years). Transoesophageal echocardiography (TEE) demonstrated a higher sensitivity in detecting cardiac emboli than transthoracic echocardiography (TTE). TEE identified a significantly higher number of emboli than TTE (48 vs. 40, p < 0.05). TEE was also associated with a lower risk of complications than TTE (0 vs. 2 cases, p < 0.05). Conclusion: In evaluating cardiac emboli in AFib patients, transoesophageal echocardiography (TEE) showed superior diagnostic accuracy and a lower complication risk than transthoracic echocardiography (TTE). Therefore, TEE may be considered the preferred imaging modality for this patient population.

EVALUATING THE ROLE OF CERVICAL LENGTH MEASUREMENT IN PREDICTING PRETERM BIRTH: A SYSTEMATIC ANALYSIS

B KHADIJA , W HAQ , F AWAN , BK YOUSAFZAI — Sun, 21 Jan 2024 00:00:00 +0000

Evaluating cervical length measurement as a predictive tool for preterm birth is a critical focus in obstetrics and maternal-fetal medicine. The primary aim of this study is to find the role of cervical length measurement in predicting preterm birth. This prospective study was conducted in Lady Reading Hospital Peshawar from 2022 to 2023. Two hundred twenty pregnant females in their second trimester were recruited from the hospital's OPD. Baseline information is collected, including socio-demographic factors, clinical and medical history, and obstetric records. A transvaginal ultrasound assesses cervical length using standardised techniques. Baseline measurements serve as the initial data point for subsequent evaluations. Data were collected from 220 pregnant females. The mean age was 28.5 years (±4.2), and the gestational age was 22 weeks (18-24). The average BMI stood at 25.1 kg/m² (±3.5). Non-smokers constituted the majority, accounting for 81.8%, while smokers comprised 18.2% of the cohort. The mean cervical length at 22 weeks was 35.4 mm (±4.6), ranging from 25 mm to 45 mm. The incidence of preterm birth stood at 14% (n=31), with 27% (n=17) of individuals having a cervical length ≤25 mm experiencing preterm birth, whereas 8% (n=14) with a cervical length >25 mm faced the same. Progesterone was administered to 27.3% (n=60) of participants, while 72.7% (n=160) did not receive it. It is concluded that cervical length assessment at 22 weeks gestation presents a valuable predictor for preterm birth incidence within this cohort. The study highlighted a significant correlation between a cervical length of 25 mm or less and an increased risk of preterm delivery.

FACTORS ASSOCIATED WITH OUTCOMES IN LAPAROSCOPIC COLONIC SURGERY: A ANALYSIS OF EARLY EXPERIENCE

R ULLAH , Y BABAR , M SHAH , A KHAN — Sun, 18 Feb 2024 00:00:00 +0000

Laparoscopic-assisted colonic (LAC) surgery has gained acceptance for various colonic diseases, yet comprehensive studies on diverse patient demographics and procedural outcomes are essential. This study aimed to evaluate 96 LAC surgeries, examining patient characteristics, surgical procedures, conversion factors, and perioperative outcomes. A one-year case series conducted at multiple centers, including the Department of General Surgery, MRHSM Hospital Pabbi Nowshera, Jinnah Teaching Hospital Peshawar, Cat C Hospital Tangi Charsadda, and DHQ Hospital Daggar Buner, Khyber Pakhtunkhwa, Pakistan in the duration from January 2023 to December 2023. Demographic diversity, prevalent colonic conditions, and detailed surgical procedures were analyzed. Conversion factors and perioperative outcomes, aligned with international standards, were documented. The cohort displayed diverse demographics, with predominant male participation. Surgical interventions, notably right hemicolectomy, demonstrated variable distributions. Conversion to open surgery was infrequent and primarily associated with locally advanced disease. Perioperative outcomes aligned with global findings, emphasising reduced pain, accelerated recovery, and shorter hospital stays. This study contributes valuable insights into the safety and efficacy of LAC across varied colonic diseases, supporting its role in modern colorectal surgery. The findings underscore the importance of careful patient selection and affirm the procedure's favourable perioperative profile.

COMPARISON OF EFFICACY OF PDE5 INHIBITORS (SILDENAFIL) VERSUS ALPHA-BLOCKERS (TAMSULOSIN) IN TREATMENT OF LOWER URINARY TRACT SYMPTOMS (LUTS) SECONDARY TO BENIGN PROSTATIC HYPERPLASIA

IU HAQ , . SHAHJEHAN, G GHOUS , HR ASGHAR , A RIZWAN , U HANIF — Mon, 11 Mar 2024 00:00:00 +0000

Benign prostatic hyperplasia (BPH) is a prevalent condition leading to lower urinary tract symptoms (LUTS) in men, affecting their quality of life. Various medications, including phosphodiesterase five inhibitors (PDE5-Is) and alpha-blockers (ABs), are used for treatment, but direct comparison studies between these drugs are limited. This study aimed to compare the efficacy of sildenafil (PDE5 inhibitor) versus tamsulosin (alpha-blocker) in patients with LUTS secondary to BPH. A randomized controlled trial was conducted at the Department of Urology, KEMU/Affiliated Hospital, Lahore. A sample size of 100 patients (50 in each group) was calculated using the WHO calculator based on expected efficacy rates. Patients aged 40-70 years with BPH and LUTS were included. Exclusion criteria included high PSA levels, history of prostatic surgery, acute urinary retention, or active urinary tract infection. Patients were randomly assigned to receive sildenafil 25mg OD or tamsulosin 0.4mg HS for three months. Efficacy was assessed by changes in the International Prostate Symptom Score (IPSS) after treatment. The demographic characteristics of the study population showed a mean age of 60 years with a similar distribution of comorbidities between the groups. After three months of treatment, 80.9% of patients in the sildenafil group showed a significant improvement in IPSS compared to 55.5% in the tamsulosin group. The chi-square test indicated a significant difference in efficacy between the two groups (p < 0.05). Sildenafil demonstrated superior efficacy compared to tamsulosin in reducing LUTS secondary to BPH. These findings suggest that sildenafil may be considered as a first-line treatment option for patients with BPH and LUTS.

FACTORS INFLUENCING INTEGRATED MANAGEMENT OF NEWBORN CHILDHOOD ILLNESSES (IMNCI) UPTAKE AMONG CHILDREN IN CMH GILGIT, PAKISTAN

NA BURIRO, A FATIMA, SA KHAN, SE ZEHRA, V KUMAR, F JOKHIO, MH KHOSO — Sat, 23 Mar 2024 00:00:00 +0000

In developing countries, about 9 million children die before reaching the age of 5 every year, with 70% of these deaths attributable to five central diseases (measles, diarrhea, pneumonia, malaria, and malnutrition). The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) have recognized the importance of early care-seeking and have developed the "integrated management of childhood illness" to promote proper healthcare practices within families and communities and decrease the mortality rate of children under five in developing countries. This study aimed to improve the health-seeking behaviour of mothers and reduce the burden of disease in children under five, with specific objectives to assess the factors affecting the uptake of integrated management of childhood illness (IMNCI) and the health-seeking behaviour of mothers. Using a structured questionnaire, a hospital-based cross-sectional study was conducted on 156 randomly selected parents of patients at CMH, Gilgit, from August to December 2016. The chi-square test determined associations between different factors and mothers' health-seeking behaviour. The results showed strong associations at p=0.05 and a 95% confidence interval with n=156. Strong associations were found between the first care given and the head of the family (p=0.02) and between health problems and the head of the family (p=0.01). The findings also indicated a strong relationship between the head of the family and restrictions when seeking care for a sick child (p=0.00). Maternal education positively impacts health outcomes, leading to fewer family restrictions, early identification of problems, and improved decision-making when seeking healthcare.

EVALUATION OF THE PREDICTORS OF SUCCESSFUL VAGINAL DELIVERY IN WOMEN AFTER PREVIOUS CAESAREAN SECTION, A PROSPECTIVE STUDY IN A TERTIARY CARE HOSPITAL

SS FATIMA, SS HUSSAIN, A FARWA, S BAWAR — Tue, 30 Jan 2024 00:00:00 +0000

A study was conducted to determine the factors that contribute to a successful vaginal delivery in women who have previously undergone one lower-segment caesarean section. This study was conducted over six months, with the approval of the Institutional Research Committee. During the third trimester of their pregnancy, women carrying a single fetus with the cephalic presentation, who had previously undergone a lower uterine segment caesarean section, were given comprehensive information about the Trial of Labour After Caesarean (TOLAC) and Vaginal Birth After Caesarean (VBAC) during their prenatal visits. Upon arrival at the labour ward for induction of labour or during the early stages of labour, the women were asked for their consent to participate in the study. The relevant data was recorded on a pre-established, organised Performa. The study included 152 pregnant women, out of which 65 (42.8%) had a successful VBAC, while 87 (57.2%) failed to have a successful VBAC. The predictors of successful VBAC were identified as a history of previous VBAC or vaginal delivery and cervical dilation of more than 3cm upon admission. From this study, it can be concluded that in carefully selected cases, a trial of labour can be given to women with a history of prior CS in a tertiary care hospital where facilities for rigorous maternal and fetal monitoring are available.

FACTORS ASSOCIATED WITH DEVELOPING CHRONIC DAILY HEADACHE IN MIGRAINE PATIENTS

Z AYAZ , Z ALI — Tue, 27 Feb 2024 00:00:00 +0000

To examine the factors associated with developing chronic daily headache in migraine patients. Two hundred patients with migraine were selected for this descriptive study conducted from 01-Sept-2023 to 30-Nov-2023 at the Department of Medicine, Lady Reading Hospital, Medical Teaching Institution, Peshawar. Factors associated with developing chronic daily headache were assessed. SPSS 23 was employed for analyzing the data. The mean age was 38.09±12.03 years. The frequency of chronic daily headache in our study was 31 (15.5%). Female gender (p = 0.02), smoking (p = 0.0001), high caffeine intake (p = 0.0001), painkiller overuse (p = 0.0001) and obesity (p = 0.0001) were factors significantly identified for developing chronic daily headache. We conclude that the factors for developing chronic daily headache in migraine patients were female gender, smoking, high intake of pain relieving medicines, high intake of caffeinated drinks and obesity.

ASSESSMENT OF SURGICAL TREATMENT STRATEGIES OF IATROGENIC GIANT FEMORAL ARTERY PSEUDOANEURYSMS

RA YAQOOB , MA MUSTAFA , GM ZAFAR , MAA JAVAID , UB BUTT — Tue, 02 Apr 2024 00:00:00 +0000

Iatrogenic giant femoral artery pseudoaneurysms pose significant clinical challenges, necessitating prompt intervention to prevent complications. Despite advancements in endovascular techniques, optimal surgical strategies remain unclear. This study aimed to evaluate surgical treatment's technical and clinical outcomes for these pseudoaneurysms. Objective: To assess the technical success and clinical outcomes following surgical repair of iatrogenic giant femoral artery pseudoaneurysms. Methods: This retrospective cohort study was conducted at a tertiary care hospital in Lahore, Pakistan between July 2022 and July 2023. A total of 60 patients diagnosed with iatrogenic giant femoral artery pseudoaneurysms underwent surgical repair. It was followed up for one, three, and six months using Duplex ultrasound and CT angiography. Data were analyzed to evaluate surgical techniques, technical success rates, and postoperative outcomes. Statistical analysis was performed using descriptive statistics and chi-square tests. Results: All patients (n=60) underwent successful surgical repair with various techniques: primary repair (n=30), repair with vein patch angioplasty (n=15), interposition reversed saphenous vein graft (n=10), and interposition synthetic Dacron graft (n=5). Technical success was achieved in 100% of cases, with no limb loss or intraoperative/postoperative mortality. The presenting symptoms were resolved in all patients, with one case of postoperative groin wound infection being effectively managed with antibiotics and debridement. Conclusion: Open surgical repair of femoral pseudoaneurysms demonstrates excellent technical feasibility and serves as a first-line treatment for iatrogenic giant femoral artery pseudoaneurysm-associated complications. These findings support surgical intervention as a practical approach to managing these challenging cases.

EVALUATION OF MIGRAINE AWARENESS AND ITS IMPACT ON STUDENTS OF NISHTAR MEDICAL UNIVERSITY

M NOMAN , MZ JAVID , MF JAMIL , A MANZOOR , M SHAHID , MK LATIF — Mon, 19 Feb 2024 00:00:00 +0000

The cross-sectional study was conducted in Nishtar Medical Hospital from January 2022 to January 2023 to assess the prevalence, impact, and triggers of migraine in medical students. The study included both male and female students from all the years. The data was collected using a questionnaire containing questions regarding demographics, knowledge about migraine, character of pain, triggers, and accompanying factors. The questionnaire was standardised according to Migraine Disability Assessment Score (MIDAS) and International Headache Society (IHS) criteria. A total of 500 students were invited, of whom 470 (94%) completed the survey. The prevalence of migraine was 25.9% (122/470), and 50% (61/122) had more than five episodes in the last three months. Over one-third, 36% (44/122) of participants experienced severe pain. Moreover, 41% (50/122) sought medical advice, and 19.6% (24/122) were hospitalised. The most common symptoms experienced during an episode were unilateral headache (81.9%), pulsating headache (65.5%), photophobia (60%), and phonophobia (55.7%). The most common triggers were sleep deprivation (73.7%), stress (57.3%), loud sounds (55.7%), hunger (53.2%), and fatigue (51.6%). Of 122, 77 (63.1%) participants reported moderate to severe disability due to migraine attacks. It is concluded that migraine is prevalent among medical students and hurt the well-being and productivity of the students.

FREQUENCY OF EMERGENCY PERIPARTUM HYSTERECTOMY AND FACTORS LEADING TO IT IN PREGNANT WOMEN AT TERTIARY CARE HOSPITAL

S IFTIKHAR , S NASEEB , S KAZI , S SHAIKH , BB ALI , S SABA — Mon, 11 Mar 2024 00:00:00 +0000

The objective of this study was to determine the frequency and factors leading to emergency peripartum hysterectomy in pregnant women at a tertiary care hospital in Karachi. This cross-sectional study was conducted at the Department of Gynaecology & Obstetrics JPMC, Karachi, Pakistan, from August 11, 2021, to February 10, 2022. All patients who met the inclusion criteria and visited JPMC, Karachi, were included in the study after obtaining consent. The study noted the factors leading to the development of emergency peripartum hysterectomy, and patients were followed by the researcher for the development of this condition. All collected data were entered into a proforma and used electronically for research. The mean maternal age was 30.04±3.87 years. Emergency peripartum hysterectomy was found in 25 (14.9%) women. The factors leading to peripartum hysterectomy were noted as placenta accreta in 5 (20.0%) women, placenta increta in 3 (12.0%) women, and placenta percreta in 17 (68.0%) women. It can be concluded that peripartum hysterectomy is prevalent in pregnant women, with placenta percreta being the common factor leading to peripartum hysterectomy, followed by placenta accreta. Further large-scale work is recommended for the validation of the current findings.

A COMPARATIVE ANALYSIS OF DIRECT STENTING VERSUS PRE-DILATION IN ST-ELEVATION MYOCARDIAL INFARCTION

SB SHAH — Thu, 28 Mar 2024 00:00:00 +0000

A major cardiovascular emergency, ST-Elevation Myocardial Infarction (STEMI), needs prompt and efficient intervention to restore blood flow to the ischemic myocardium. The decision between direct and pre-dilation stenting, two of the many techniques used in primary percutaneous coronary intervention (PCI), has been a topic of continuous discussion. This comparative study was performed at Ayub Teaching Hospital Abbottabad after obtaining approval from the ethical review committee for six months. A total of 75 patients were included in this study and were divided into two groups. The documented procedural outcomes were the use of Gp IIb/IIIa inhibitors, procedure time, total procedure cost, and procedural problems. The rates of the left ventricular ejection fraction (LVEF) at discharge, ventricular fibrillation, all-cause death, and a composite of major adverse cardiac events at 30-day follow-up were documented. The results have shown that Group A has 2.44% cases of no re-flow and no abrupt closure or dissection occurrences. Group B's incidence rates were 5.88%, 2.94%, and 5.88%, respectively. The procedural time, Group A had an average of 33 ± 19 minutes, while Group B recorded a longer procedural time of 41 ± 17 minutes. Postoperatively, Group A showed a mean LVEF of 49.2 ± 8.8, no cases of cardiogenic shock or stroke, and a mortality rate of 2.44%. In contrast, Group B had a mean LVEF of 48.9 ± 9.2, encountered cardiogenic shock in 5.88% of cases, experienced a stroke in 2.94%, and recorded a mortality rate of 2.94%. Additionally, both groups exhibited ST-segment resolution, with rates of 80.49% in Group A and 67.64% in Group B. The analysis of patients undergoing coronary intervention for ST-elevation myocardial infarction (STEMI) suggests that direct stenting may yield more favorable results compared to pre-dilation.

PREVALENCE AND ANTIBIOTIC SUSCEPTIBILITY PATTERN OF HELICOBACTER PYLORI ISOLATES FROM GASTRIC BIOPSIES OF PATIENTS IN TERTIARY CARE HOSPITAL

S FATIMA , I ULLAH , M AYAZ , K MALIK , MNQ SHAIEA , X YAN , L HAN , L ZHAO — Tue, 30 Jan 2024 00:00:00 +0000

Worldwide, Helicobacter pylori is prevalent and is strongly associated with causing numerous digestive tract infections. Combination therapy for this pathogen includes a combination of antimicrobials such as amoxicillin, metronidazole, clarithromycin, levofloxacin, and proton pump inhibitors. Even though the present therapy is effective, treatment failure has been observed. This failure has been observed to be mainly due to point mutation, which in H. pylori is considered the primary developed resistance mechanism. This study investigated the prevalence and drug susceptibility of H. pylori in patients in Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan, from 2016 to 2017. A total of 100 gastric biopsies of patients were included in our study. All the samples were cultured and identified by biochemical testing for H. pylori to determine the prevalence. The disk diffusion method was used for the determination of the susceptibility pattern. Among 100 patients, H. pylori strains were isolated from 52 (52%) patient samples. To metronidazole (MTZ), maximum number of isolates (69.23%) shows resistance. Resistance to other antibiotics was also detected, including clarithromycin (CLR; 50%) and amoxicillin (AML; 57.69%). Comparatively low resistance was observed to tetracycline (TET; 7.69%) and ciprofloxacin (CIP; 15.38%) by a few isolates in our study. These data suggest that metronidazole should be used among Pakistani patients in first-line therapy with caution and ciprofloxacin in association. The clinician must know their area's resistance patterns when selecting an empiric antibiotic regimen for H. pylori.

TREATMENT WITH SILDENAFIL CITRATE IN RENAL TRANSPLANT PATIENTS WITH ERECTILE DYSFUNCTION

KU REHMAN , FE MANAN , I ULLAH , H MINALLAH — Thu, 29 Feb 2024 00:00:00 +0000

Erectile dysfunction (ED) is a prevalent and distressing condition among renal transplant patients, often stemming from multifactorial causes such as medication side effects, psychological factors, and vascular complications associated with end-stage renal disease (ESRD) and transplantation. The basic aim of the study is to find the treatment with sildenafil citrate in renal transplant patients with erectile dysfunction (ED). This prospective observational study was conducted at the Institute of Kidney Disease Peshawar from 2017 to 2023. A total of 240 participants were recruited using convenience sampling methods. All male patients aged 18 years or older who had undergone renal transplantation and reported persistent ED for a duration of at least six months post-transplantation. Patients who use nitrate medications, severe cardiovascular disease, and uncontrolled hypertension were excluded from the study. Data were collected from 240 patients. The mean age of the patients was 52 ± 8.01 years and the mean duration of the transplant was 5.1 ± 3.2 years. Almost 70% of patients were suffering from hypertension, 45% from DM, and 30% from CVD. The mean level of serum creatinine was 1.5 ± 0.3 mg/dl and the mean GFR was 60 ± 10mL/min/1.73m². The assessment at baseline revealed an IIEF erectile function score of 12.5, which significantly improved to 20.2 at the 12-week follow-up, indicating a notable enhancement in erectile function among participants. Moreover, the frequency of successful intercourse also exhibited a positive change, with participants reporting an increase from 1-2 times per month at baseline to 3-4 times per month at the 12-week. It is concluded that sildenafil citrate demonstrates significant efficacy in improving erectile function and sexual satisfaction among renal transplant patients with erectile dysfunction.

FRACTIONAL FLOW RESERVE–GUIDED PCI IN PATIENTS WITH MULTI-VESSEL CORONARY ARTERY DISEASE

A BASIT , . YUSRA, AQ MEMON , Z ULLAH , M IRSHAD , MA ILYAS , M ABDULLAH — Sat, 30 Mar 2024 00:00:00 +0000

In multi-vessel coronary artery disease (CAD), there is insufficient data to support the use of fractional flow reserve (FFR) to guide treatment beyond candidates for coronary graft surgery or percutaneous coronary intervention. Objectives: The purpose of this study was to investigate whether the treatment based on FFR is more effective in lowering the ‘cumulative rate of death’, ‘myocardial infarction’, ‘stroke, or unexpected coronary revascularization in patients who have multi-vessel CAD than a ‘traditional strategy based on coronary angiography without FFR’. Methodology: A retrospective cross-sectional study involving 1200 participants, i-e, 607 in the control group and 593 in the FFR group. This study was conducted at the National Institute of Cardiovascular Diseases (NICVD) from June 2021 to July 2022. Multi-vessel CAD candidates were randomised (1 to 1) to either a conventional treatment plan without FFR or an intervention plan ‘based on FFR in all stenotic (≥50%) coronary arteries. ‘Revascularization (percutaneous coronary intervention or surgery)’ was recommended for FFR ≤0.80 lesions in the FFR group. A significant ‘adverse cardiac or cerebrovascular event at one year served as the primary outcome. Results: After a safety investigation and the enrollment of 1200 patients, the data safety and monitoring board decided to terminate the trial early. The results showed no appreciable variations in the frequencies of major adverse cardiac or cerebrovascular events among the FFR and control groups at the one-year monitoring, according to intention to treat. A 24-month extended follow-up confirmed no significant difference in all-cause mortality between the FFR group and the control group. More individuals were referred solely for medical care when FFR dramatically decreased the percentage of revascularised individuals. Conclusion: An FFR-guided approach reduced revascularisation rates compared to angiography only and almost doubled the rate of OMT alone among individuals with multi-vessel coronary artery disease. However, the FFR-guided approach had no discernible impact on the clinical results at one year, determined mainly by the SYNTAX score and left ventricular function. The current study indicates that while FFR alone does not affect clinical results, it does assist in selecting the best revascularisation approach.

PATTERN OF ANTIBIOTIC SENSITIVITY IN TYPHOID FEVER PATIENTS WITH POSITIVE BLOOD CULTURE: AN OBSERVATIONAL STUDY

Z KHAN , AM KHAN , A BASIT , MA KHAN , A ALI — Fri, 05 Jan 2024 00:00:00 +0000

Salmonella typhi is a type of bacteria that can cause typhoid fever, a severe infection that primarily affects people in developing countries. It is a significant public health concern. An antibiogram test was conducted by the Department of Medicine at MTI, LRH Peshawar, to test antibiotic susceptibility in samples that tested positive for typhoid culture from January 2023 to July 2023. The Kirby-Bauer disk diffusion method was used to evaluate the antibiotic susceptibility of Salmonella isolates on Mueller-Hinton agar. IBM SPSS version 22 was used to analyze all of the data. In total, 90 people participated in the research, with 40 percent being female and 50 percent male. Of the Salmonella isolates, 08 (28.20%) were sensitive to typhoid, 18 (68.80%) were MDR, and 01 (04%) were XDR. Of the 27 isolates, 6 (21.40%) showed Ampicillin sensitivity, while 21 (81.40%) showed resistance to the antibiotic. 90.20% of the isolates were resistant to chloramphenicol, while 15.60% were susceptible. 60.20% of the isolates were resistant to ceftriaxone, while 41.40% showed sensitivity to the drug. Nine isolates (30.40%) showed sensitivity to ciprofloxacin, while eighteen isolates (68.40%) showed resistance. 26 27 isolates (91.40%) showed sensitivity to azithromycin, while 01 (02.40%) showed resistance. Meropenem was the most effective antibiotic, with 100% of the isolates exhibiting Meropenem sensitivity. Based on the findings, azithromycin and meropenem are the most effective antibiotics against isolates of Salmonella spp. MDR and XDR strains of enteric fever are on the rise and exhibit a high degree of resistance to commonly prescribed medications. Antibiotic use without a prescription should be minimized, and prescribing practices should be modified.

BURDEN OF ANEMIA AND ASSOCIATED FACTORS AMONG PREGNANT WOMEN AT KAUSAR HOSPITAL MOTHER AND CHILD HEALTH CARE CENTRE KHAIRPUR MIR’S, PAKISTAN

N BALOUCH, S WAHEED, T WAHEED, KH MEMON — Thu, 21 Mar 2024 00:00:00 +0000

Anemia is the condition in which hemoglobin level may become lower than normal <11.0g/dl. According to an estimate, about one-third of the world's population (over 2 billion) are anemic. The study aimed to determine the Prevalence of anemia and associated factors among pregnant women at Kausar Hospital Mother and Child Health Care Centre Khairpur Mir’s, Sindh, Pakistan. The cross-sectional study was conducted from August to December 2019. A total number of 100 pregnant women were randomly included in this study. A predesigned questionnaire was filled out by face-to-face interviews consisting of socio-demographic characteristics, including Name, Age, gestational age, educational level, occupation, and monthly income. Anemia was classified as per World Health Organisation (WHO) criteria. The prevalence rate of Anemia in the present study was 69%. Minimum Haemoglobin levels were observed at 5.6 g/dL, and maximum Haemoglobin levels were observed at 12.4 g/dL with an average Haemoglobin of 10.05 g/dL ±1.44. Among them, 49% had mild anemia, 17% moderate anemia, and 3% severe anemia. At the same time, the patients were divided into age groups of 15-20 years, 21 to 25 years, 26 to 30 years, and 31-35 years to compare Anemia or Haemoglobin levels. Results showed a higher prevalence of anemia between the ages of 26 and 30. The minimum age was observed to be 20 years and a maximum of 35 years, with an average age of 28.12 years ±2.5 years. It was observed that the prevalence of Anemia was higher in 7-9 gestational months; socio-economic factors (Age, Gestational month, Number of children, and income source) showed significant association with Anemia. The present study concludes that the Prevalence of Anemia and Associated Factors among Pregnant Women at Kausar Hospital was 69%. Among them, 49% had mild anemia, 17% moderate anemia, and 3% severe anemia.

CLINICAL EVALUATION OF FIXED PARTIAL DENTURE IMPRESSION

N HAYAT , JU HADI , F ULLAH , . FAISAL, S FARYAL , B SIRAJ — Thu, 14 Mar 2024 00:00:00 +0000

Accurate impressions of teeth and the area to be restored are required in fixed Prosthodontics treatment for the laboratory to fabricate the desired restoration without any faults. The study aimed to raise awareness about the importance of improving individual skills to minimise impression errors, provide patients with high-quality prosthetics, and enhance their comfort. The study's objectives were to evaluate the clinically detectable errors in the impressions and to determine co-relations between possible risk factors that cause impression errors. This study follows a descriptive cross-sectional study design, which involves the probability convenience sampling technique, consisting of 150 impressions studied for the type of tray, type of material, type of technique, type of prosthesis ordered, arch of impression involved, size of tray, number of units prepared and retraction cord used. Impression errors were also assessed, including finish line errors, tears in the finish line, air bubbles, voids, and blood formed in the impression. Data were analysed with SPSS version 25.0, and correlations were found through a chi-square test. One hundred fifty impressions were analysed, with 80 being maxillary arch impressions. Most impressions utilised full arch trays (91.33%), with Monophase being the predominant technique (77%). Alginate emerged as the most commonly employed impression material (76%), and the most commonly used tray was the full arch tray (137). Crown preparations accounted for 70% of cases. Notably, retraction cord usage was observed in 58.7% of impressions. The study analysed 150 Impressions, finding 56.7% finish line errors, 21.3% tears, 19.3% bubbles, 80.7% voids, and 6% traces of blood. Our study reveals that material type, impression technique, no crown, arch of impression, prosthesis ordered, and retraction cord have a significant association (P < 0.05) with the impression errors, except tray type having no significant association (P > 0.05) with the impression errors. Based on the study's outcomes, this research identifies alginate and the monophase technique as prevalent choices among clinicians. The most common were voids and finish line errors, with tray selection showing no significant impact. The use of retraction cords notably reduces impression errors, indicating a strong association. Overall, crown impressions exhibit greater accuracy compared to bridge impressions.

POSTPARTUM DEPRESSION AND SOCIAL SUPPORT: A CROSS-CULTURAL ANALYSIS OF THE PAKISTANI POPULATION

A ISMAIL , M DAR , S JAFFRI , SS IQBAL , MA MUHAMMED , F JAHAN — Sat, 23 Mar 2024 00:00:00 +0000

The study investigates the prevalence of depression among pregnant women and its association with demographic, maternal, and socioeconomic characteristics. Participants were recruited for a year from healthcare facilities from Rural Health Center Kangra, District Haripur, Khyber Pakhtunkhwa, Ayesha Sakeena Medical Complex, Raiwind, Lahore, Creek General Hospital, Korangi, Karachi and Ayub Teaching Hospital, Abbottabad, Khyber Pakhtunkhwa, from September 1, 2022, to August 31, 2023. Among 374 women screened for depression, 39.03% screened positive, with a final sample of 179 pregnant women analyzed. Participants, predominantly aged 21-28, were in the second (81%) or third (19%) trimester. Maternal depression (64%) was linked to factors like inadequate income, lack of empowerment, poor wealth index, family debt, and insufficient funds for food. Socioeconomic challenges, coupled with inadequate social support and extensive household responsibilities, contribute to the complex landscape of maternal depression. Comprehensive interventions addressing economic hardships, mental health support, and social networks are crucial for improving maternal well-being during pregnancy.

KNOWLEDGE, ATTITUDE, AND PRACTICE REGARDING IMMUNIZATION AMONG MOTHERS OF INFANT AND PRESCHOOL CHILDREN AT A TERTIARY CARE HOSPITAL, IN KARACHI.

M KHAN , JU AKBER , S SOHRAB , AH KHAN , MHU HAQ , AA ALI — Mon, 29 Jan 2024 00:00:00 +0000

The objective of this research was to determine the knowledge, attitude, and practice of mothers of infant and preschool children regarding immunization. The study will be conducted at a tertiary care hospital in Karachi, and a total of 119 people will be recruited for KAP research. The mothers' level of education, beliefs, and behaviors will be assessed along with factors such as a child's age, gender, place of birth, number of siblings, marital status, educational level, employment status, and monthly income. The principal investigator will gather information using a self-designed questionnaire that includes questions on demographics and immunization-related knowledge. The results of the study indicate that 68.9% of the mothers had knowledge of immunization, whereas 31.1% did not. In addition, 68.1% of the mothers were aware of the Expanded Program on Immunization (EPI), while 31.9% were not. Regarding knowledge of the EPI 1st dose, 69.7% of the mothers had information about it, while 30.3% did not. Only 28.6% of the respondents had knowledge of diseases that could occur in the absence of vaccination, whereas 71.4% did not. In terms of specific diseases, 5.9% were aware of diphtheria, 5.9% of polio, 5% of tetanus, and 11.8% of influenza. However, 71.4% of the respondents did not have knowledge of diseases that could occur in the absence of vaccination. Furthermore, 35.3% of the parents expressed fear of immunization for their children, while 64.7% did not. Among those who had fears, 52.9% believed that there was no benefit to immunization, and 47.1% were concerned about harm to their children. In conclusion, the study found that more than half of the mothers who expressed fear of immunization did so because they believed there was no benefit. This highlights the need for more education and awareness campaigns to help parents understand the importance of immunization in preventing diseases and keeping their children healthy.

AUDIT OF COVID-19 WARD PERFORMANCE AND PRACTICE IN THE COVID-19 PANDEMIC: FUTURE DIRECTIONS FOR UNDERSTANDING: A RETROSPECTIVE STUDY

F AFRIDI , F GHAYAS , S ANWAR , MA SHEIKH — Wed, 21 Feb 2024 00:00:00 +0000

A retrospective study was conducted to assess the trend of the COVID-19 pandemic in the COVID Ward emergency and COVID Ward treatment departments of the Department of COVID Ward at POF Hospital Wah Cantt from January 2021 to January 2022. Data on every patient admitted to the COVID Ward department over a year was gathered retroactively. The following demographic factors were recorded: diagnosis, COVID-19 work-up, admission specialization, and COVID-19 ward vs. conservative therapy. In total, there were 156 patients, with 108 being primarily men (70.4%). Of these patients, 90 (72%) were admitted via the clinic, and 124 (46%) were admitted in May. One hundred five patients (62.8%) had a COVID-19 PCR, 135 had a chest x-ray (90.2%), and 56 patients (31.4%) had a chest HRCT. The orthopedic COVID Ward was the most common department for operational interventions, with 88.4% of patients undergoing operative care, despite the general COVID Ward being the busiest service line with 89 total patient admissions (43.1%). The study found that the existing local protocols for patient flow and COVID-19 crisis management are effective and practical. Hospitals should be prepared to redirect their resources to high-volume specialties like orthopaedics and general COVID Wards after the later COVID-19 waves. Arteriovenous fistula formation is a simple yet crucial technique that should only be discontinued in the event of a labor shortage.

ASSESSMENT OF ANTERIOR CHAMBER ANGLE ON ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY IN PATIENTS WITH ANGLE CLOSURE GLAUCOMA AND ANGLE CLOSURE SUSPECTS

SA Bhutto, AA LEGHARI , NA KATPAR, Z GOPANG, DYD SHAIKH, PA GUL — Tue, 19 Mar 2024 00:00:00 +0000

The objective of this cross-sectional study was to determine the anterior chamber angle using anterior segment optical coherence tomography (AS-OCT) in patients diagnosed with angle closure glaucoma and angle closure suspects. The research was conducted at Shaheed Mohtarma Benazir Bhutto Medical University Larkana, spanning from March 3, 2022, to June 30, 2023. Patients meeting the inclusion criteria and diagnosed with primary angle-closure glaucoma (PACG) were enrolled in the study after obtaining informed consent. The procedure, risks, and benefits of the study were explained to the patients before obtaining consent. AS-OCT was utilized to evaluate patients suspected of primary angle closure and those with confirmed primary angle closure. The results revealed a mean age of 56.21 ± 12.31 years among the study participants, with a confidence interval of 55.04 to 57.38. The mean duration of primary angle closure glaucoma was 22.52 ± 10.98 months, with a confidence interval of 21.47 to 23.57. Of the 423 patients included in the study, 219 (52%) were male, and 204 (48%) were female. Primary angle closure suspect and primary angle closure were observed in 47 (11%) and 44 (10%) patients, respectively. In conclusion, older age, higher central corneal thickness (CCT), and shorter axial length or presence of hyperopia were identified as important independent predictors of suspicion of primary angle closure and primary angle closure. These findings underscore the significance of thorough assessment and monitoring of these parameters in patients at risk of angle closure glaucoma.

ANTIMICROBIAL RESISTANCE IN SALMONELLA ENTERICA SEROVAR TYPHI: UNDERSTANDING THE MECHANISMS AND PATHOGENICITY OF INFECTION” A COMPREHENSIVE REVIEW

A ANWAR , N AYAZ , S AHMAD , . HAFSA, F NAZ , K NADIR — Thu, 18 Jan 2024 00:00:00 +0000

Typhoid Fever is a contagious disease caused by Salmonella enterica serovar typhi. It is also the cause of bloodstream infections in most of the developing countries. The pathogen can escape from the host’s immune response, a feature linked with the capsular structure of bacteria, which contributes to its virulence and is a crucial factor in the dissemination of infection. Salmonella enterica serovars are classified as typhoidal and nontyphoidal salmonella. In this review, we will discuss the ecumenical occurrence of immune strains of Salmonella enterica. We cover the mechanism of antimicrobial resistance in Salmonella, including plasmid-mediated resistance. Antibiotic resistance can occur through various mechanisms, such as deactivation of antibacterial medications, changes in therapeutic targets, and acquisition of foreign DNA coding for resistance determinants through horizontal gene transfer. Additionally, bacteria can employ different efflux pumps to resist antibiotics. These are some of the common ways in which antibiotic resistance is developed. We will explore the factors contributing to its virulence, such as the improper use of antibiotics, gene transfers, recurrent infections, and reduced host immunity. Proper hygiene practices and accurate treatment are necessary to combat typhoid disease, which can be better understood by studying its pathogenesis and diagnosis. The widal test and Typhidot test are essential for the diagnosis of salmonella. Vaccines are available against typhoid. We can overcome disease development through vaccination by choosing safe delivery methods and control strategies.

IMPACT OF MALNUTRITION ON PEDIATRIC HEART FAILURE ANALYZING Z-SCORES AT PRESENTATION

ZA YOUSAFZAI, S ILYAS, Z NAWAB, . ABDULLAH — Fri, 22 Mar 2024 00:00:00 +0000

Pediatric heart failure represents a critical health concern characterized by the heart's inability to effectively pump blood, often resulting from congenital heart defects, myocarditis, and cardiomyopathies. Malnutrition has emerged as a recognized comorbidity in pediatric heart failure, significantly impacting patient outcomes. This study aimed to investigate the relationship between malnutrition and pediatric heart failure by analyzing Z-scores at presentation to guide targeted interventions and improve patient management. The study employed a retrospective observational design and was conducted at the Department of Pediatric Cardiology, Lady Reading Hospital, Peshawar, from January 2023 to January 2024. A total of 764 pediatric patients with heart failure were included in the analysis. Nutritional status was assessed using weight and height measurements, and Z-scores were calculated based on WHO Child Growth Standards. Data analysis was performed using IBM SPSS version 22. Results revealed varying degrees of malnutrition among pediatric heart failure patients, with 62.8% classified as severely malnourished, 28.4% as moderately malnourished, and 8.8% as mildly malnourished. The calculated Z-score of -3.2 indicated significant malnutrition among the study population. Furthermore, a negative correlation (r = -0.32, p < 0.001) between Z-score and left ventricular ejection fraction was observed, suggesting a link between malnutrition severity and cardiac dysfunction. These findings underscore the high prevalence of malnutrition among pediatric heart failure patients and its substantial impact on outcomes. Early nutritional assessment and intervention are crucial for optimizing patient care and enhancing outcomes in children with heart failure. Collaborative, multidisciplinary approaches that integrate cardiac and nutritional management strategies can comprehensively address the diverse needs of this vulnerable population.

NURSES' ATTITUDE TOWARDS PATIENTS WITH MENTAL ILLNESS IN A TERTIARYCARE HOSPITAL

S HAYDER , S ANDLEEB , S AHMED — Thu, 28 Mar 2024 00:00:00 +0000

Nurses play a crucial role in the care of patients with mental illness, yet their attitudes towards these patients can significantly impact the quality of care provided. This study aimed to assess nurses' attitudes towards patients with mental illness in a general hospital setting. A cross-sectional survey was conducted among 150 nurses working in various hospital departments. The Attitudes Towards Mental Illness (ATMI) scale was utilized to measure nurses' attitudes. Results revealed that most nurses held positive attitudes towards patients with mental illness, with a mean ATMI score of 75.4 (SD=6.8) out of 100. However, a subgroup analysis identified variations in attitudes based on nurses' years of experience and department of work. Nurses with more years of experience tended to exhibit more positive attitudes toward mental illness. At the same time, those working in acute care settings showed slightly more negative attitudes compared to those in psychiatric units. These findings underscore the importance of addressing nurses' attitudes towards mental illness to ensure the delivery of high-quality and stigma-free care to patients with mental health conditions.

EFFECTS OF ANTICOAGULANTS ON BLOOD CELLS MORPHOLOGY AND BIOCHEMISTRY

A ARSHAD, A SAFDAR, M ATIF, H HUSSAIN, M WAQAS, S MAHMOOD — Thu, 14 Mar 2024 00:00:00 +0000

Blood is a particular type of connective tissue that majorly contains red blood cells (RBCs), white blood cells (WBCs), and platelets (Plts). Anticoagulants are used to preserve the fluidity of blood and retard morphological changes in blood cells. Anticoagulants like EDTA, heparin, sodium citrate, and CPDA-1 are used. However, these anticoagulants also have some disadvantages, summarized in this review. This chemical causes the lysis of many cells, including RBCs, and some of them, like EDTA, cause agglutination of platelets, which not only causes a decrease in platelet count but also causes a spurious increase in WBC count. These substances also alter the shapes of various cells present in blood. RBCs and platelets may become spherical from the normal biconcave disc and plate-like structures. Commonly used anticoagulants contribute to alterations of many hematological parameters, including hematocrit, hemoglobin concentration, and packed cell volume of RBCs. Certain chemicals used in anticoagulant solutions, such as potassium and sodium in EDTA solution, make the blood unsuitable for determining these electrolytes in the sample. They also induce many changes in the biochemical composition of the sample. The most affected biochemical changes are observed in 2,3-DPG, D-dimer concentration, blood gas estimation, and cytokine levels. As they contain different chemicals, they have varying pH, so they alter blood pH.

CONJUNCTIVITIS INFECTION: A BRIEF REVIEW ON ITS CLASSIFICATION, ETIOLOGY AND THERAPEUTIC INTERVENTIONS

M ZULFIQAR , S RAFIQUE , A HABIB , A QADER , A ASGHAR; R RIAZ — Wed, 17 Apr 2024 00:00:00 +0000

Conjunctivitis is a common inflammatory disease in humans, and it has different types of categories, such as acute, chronic, infectious, and noninfectious. Conjunctivitis may break as an epidemic in different areas of the world. It causes discomfort in the eyes. Some signs and symptoms like redness of the eye, eye discharge, grittiness of the eyes, and lashes sticking together may appear. Based on etiologic agents, conjunctivitis is classified as viral conjunctivitis, bacterial conjunctivitis, allergic conjunctivitis, follicular conjunctivitis, and neonatal conjunctivitis. It may be due to contact with people having eye infections. Many strains of bacteria, viruses, and allergens cause different types of conjunctivitis. Many treatment strategies are applied to treat various kinds of conjunctivitis worldwide. Usually, antibiotics are used for the treatment of conjunctivitis, such as ophthalmic ointments erythromycin, chloramphenicol, and fusidic acid treatment. As a home remedy, many people wash their eyes with normal saline and water to reduce the duration of eye diseases.

MYOCARDITIS IN PEDIATRICS: A GROWING CONCERN FOR HEALTHCARE SYSTEMS IN PAKISTAN

S ILYAS , M BILAL — Sun, 10 Mar 2024 00:00:00 +0000

Myocarditis, defined as an inflammation of the heart muscle, can pose significant challenges in pediatric cardiology due to its varied causes and potentially serious consequences. While there are several potential causes of myocarditis, for instance, autoimmune diseases and toxins, viral infections account for a large majority of cases in pediatric populations (Tschöpe et al., 2021). The frequency of myocarditis is still rather high due to the increased prevalence of viral diseases in children, especially during specific seasons; this puts a significant strain on hospital resources. Myocarditis in paediatric patients has consequences that go beyond the initial inflammatory insult to the heart. Patients affected with myocarditis can often exhibit acute heart failure, arrhythmias, and, in severe cases, cardiogenic shock (Ammirati et al., 2021). Moreover, long-term consequences can manifest as chronic heart failure, which necessitates continuous, ongoing monitoring and management to optimize cardiac function and quality of life (Upadhya and Kitzman, 2020). We have noticed a worrying trend in our pediatric cardiology practice at Lady Reading Hospital Peshawar, whereby approximately half of the patients who consult our outpatient and inpatient departments have left ventricular failure. A significant portion of these cases are diagnosed as viral myocarditis. We have noticed a worrying trend in our pediatric cardiology practice: about 50% of the cases that come into our outpatient and inpatient departments have left ventricular failure, and a sizable percentage of those cases are diagnosed with myocarditis. This finding not only highlights the frequency of myocarditis but also highlights the pressing need for increased awareness, prompt diagnosis, and effective management of viral myocarditis in order to reduce negative consequences in vulnerable pediatric populations. In resource-poor environments like Pakistan managing myocarditis can unique challenges. Treatment methods such as IV immunoglobulin treatment which can have proven success in some patients, are generally expensive and not readily available (Ammirati et al., 2021). This gap in access to modern treatments can further exacerbate the load on healthcare systems that are already strained by the high prevalence of myocarditis. In low and middle-income countries (LMICs) like Pakistan, proactive preventative interventions are especially important to reduce the strain on already overburdened healthcare systems. The increased frequency of myocarditis in pediatric populations can be decreased by highlighting the significance of vaccination against common viral infections linked to the illness such as adenovirus and enterovirus (Makimaa et al., 2020; Upadhya and Kitzman, 2020). In addition, raising awareness among caregivers and medical professionals about the early detection of myocarditis symptoms and the importance of promptly referring patients to specialized clinics will help to expedite intervention and enhance long-term results (Inoue et al., 2019). In summary, the growing incidence of myocarditis in pediatric patients demands a multimodal strategy that includes early detection, prevention, and complete therapeutic techniques. By addressing these issues collectively and pushing for fair access to key treatments, we can seek to lessen the impact of myocarditis on pediatric cardiac health and alleviate the load on healthcare systems, particularly in resource-limited settings.

BRIDGING GAPS: ADDRESSING TREATMENT CHALLENGES WITH ORAL PGE2 IN DUCTUS-DEPENDENT CONGENITAL HEART DEFECTS

S Ilyas — Mon, 04 Mar 2024 00:00:00 +0000

circulation. During fetal development, it diverts approximately 90% of the right ventricular output from the high-resistance pulmonary circulation to the umbilical-placental circulation for gas exchange with maternal blood. After birth, the ductus arteriosus usually shuts within 72 hours to help with lung circulation. Failure to close leads to a persistent left-to-right shunt known as patent ductus arteriosus (PDA). PDA affects up to 80% of premature infants and constitutes 5–10% of all congenital cardiac abnormalities in term infants. Hemodynamically significant PDA is associated with various morbidities, including neurodevelopmental impairment and respiratory distress syndrome (Slaughter et al., 2019). Conversely, in ductus-dependent heart lesions, which account for 20–25% of all congenital heart defects, it is crucial to maintain patency of the neonatal DA to uphold life-saving pulmonary or systemic circulation before corrective surgery (Subramaniam and Solomon, 2013).

Treatment for closing patent ductus arteriosus (PDA) mostly involves nonsteroidal anti-inflammatory medicines (NSAIDs) such as indomethacin and ibuprofen, which block cyclooxygenase enzymes necessary for prostaglandin production. Although effective, NSAIDs carry dangers such as renal impairment and intestinal problems. Acetaminophen is considered a safer option, although its effectiveness in premature infants is unclear because it may not fully inhibit prostaglandin synthesis. However, few medications exist for preserving ductus arteriosus (DA) patency, with prostaglandin E1 (PGE1) being the sole pharmacological option despite its associated side effects, such as peripheral vasodilation, apnea, fever, and physiological disturbances (Sear, 2019). Furthermore, the shortage of PGE1 in certain countries like Pakistan highlights the urgent need for alternate solutions. In such situations, adopting other available choices like PGE2, which is accessible in Pakistan as an oral drug, becomes crucial for the efficient management of ductus-dependent congenital heart anomalies.

Prostaglandin E2 (PGE2) has been successfully utilized orally in newborns with ductus-dependent cyanotic congenital heart disease. In research by Silove et al., PGE2 was supplied orally in doses ranging from 12 to 65 micrograms/kg at 1 to 4 hours intervals. This treatment regimen resulted in consistent increases in oxygen saturation (SaO2) and plasma PGE2 concentrations within 15-30 minutes after administration, equivalent to those achieved with intravenous infusions. Treatment lasted for durations ranging from 5 days to 4 months, during which the ductus remained open for extended periods, allowing for delayed surgical intervention to support the growth of the infants and their pulmonary arteries. While adverse effects during oral medication were similar to those found with intravenous administration, they were generally less severe in this series, underlining the effectiveness and simplicity of oral PGE2 administration for long-term treatment (Nabavi et al., 2019).

Furthermore, a 1987 study by B.D. Thanopoulos et al. supported the effectiveness of oral PGE2 in the treatment of neonates with cyanotic congenital heart disease, which primarily depends on the ductus. The data from this investigation revealed that oral PGE2 treatment, while less productive than intravenous infusions, nonetheless proved useful for long-term therapy, affording more convenience and lower morbidity (Fernández-Francos et al., 2021). It is crucial to highlight that side effects such as apnea and hypotension may occur in newborns following PGE2 therapy and require close monitoring during treatment. In conclusion, oral PGE2 offers a viable alternative for addressing congenital heart defects in resource-limited countries like Pakistan. Its effectiveness and convenience make it a viable choice, especially if access to injectable drugs is limited. This underlines the necessity to investigate alternative treatments for appropriate care in such circumstances.