Pakistan Journal of Intensive Care Medicine

RISK FACTORS OF HEPATIC ENCEPHALOPATHY IN PATIENTS WITH CHRONIC LIVER DISEASE PRESENTING TO SAIDU GROUP OF TEACHING HOSPITAL, SWAT

A AZIZ — 2025-07-14

Background: Hepatic encephalopathy (HE) is a serious complication of chronic liver disease (CLD), characterized by neuropsychiatric impairment that significantly increases morbidity and mortality. Identifying key precipitating risk factors is essential for prevention and timely management. Objective: To determine the key risk factors leading to HE in patients with CLD presenting to Saidu Group of Teaching Hospital, Swat, Pakistan. Study Design: Cross-sectional study. Setting: Department of Medicine, Saidu Group of Teaching Hospital, Swat, Pakistan. Duration of Study: 12 July 2024 to 12 January 2025. Methods: A total of 107 patients diagnosed with HE and CLD were enrolled. CLD was confirmed based on clinical features, while HE was diagnosed through neuropsychiatric symptoms and magnetic resonance imaging (MRI) findings. Risk factors, including fever (oral temperature ≥38°C), upper gastrointestinal (GI) bleeding (confirmed by endoscopy), and respiratory tract infections (sputum culture with clinical correlation), were assessed. Data were analyzed using descriptive statistics. Results: The mean age of patients was 49.18 ± 14.59 years. Females constituted 66 (61.7%) and males 41 (38.3%). Among identified risk factors, upper GI bleeding was observed in 52.3% cases, fever in 35.5%, and respiratory tract infections in 12.1%. Conclusion: Upper gastrointestinal bleeding was the most common precipitating factor for HE in patients with CLD, followed by fever and respiratory tract infections. Preventive measures and timely management of these risk factors may reduce the incidence of HE and improve patient outcomes.

COMPARISON OF EFFICACY OF GLYCOLIC ACID 60% PEEL VERSUS Q-SWITCHED Nd: YAG LASER IN THE TREATMENT OF MELASMA AT TERTIARY CARE HOSPITAL OF BAHAWALPUR

A RAFIQUE — 2025-07-14

Background: Melasma is a common acquired pigmentary disorder, especially among individuals with darker skin types. Various therapeutic modalities, including chemical peels and lasers, are used to manage melasma; however, their comparative effectiveness remains a subject of ongoing clinical investigation. Objective: To compare the therapeutic efficacy and safety profile of low-fluence Q-switched Nd: YAG laser with topical 60% glycolic acid peel in the treatment of melasma. Study Design: Quasi-experimental, non-randomized controlled study. Setting: Department of Dermatology, Combined Military Hospital (CMH), Bahawalpur, Pakistan. Duration of Study: From 15 April to 14 September 2024. Methods: Eighty patients clinically diagnosed with melasma were enrolled and divided into two groups: Group A (n=40) received 60% glycolic acid peels and Group B (n=40) received low-fluence Q-switched Nd: YAG laser therapy. Each patient received treatment for a period of three months. Treatment efficacy was assessed using the Melasma Area and Severity Index (MASI) at baseline and 8 weeks. Statistical analysis included a median score comparison and a chi-square test for categorical data, with p < 0.05 considered statistically significant. Results: The peak incidence of melasma was observed in the 29–32-year age group, with a female-to-male ratio of 4:1. Sunlight exposure was the most common aggravating factor. Epidermal melasma was predominant in both groups (33.7% in Group A vs. 23.8% in Group B; p < 0.05). MASI scores showed a significant reduction in both groups: from 7.20 to 4.20 in Group A and from 5.40 to 4.10 in Group B by week 8 (p < 0.005 for both). Erythema was more frequent in Group A (18.7%) compared to Group B (2.5%, p < 0.05). However, post-inflammatory hyperpigmentation (PIH) was more common in Group B (10%) than in Group A (1.3%, p < 0.05). Conclusion: Topical 60% glycolic acid peel demonstrated greater therapeutic efficacy and a better safety profile than low-fluence Q-switched Nd: YAG laser in the treatment of melasma. PIH was notably more frequent in patients treated with laser, particularly those with darker skin types. Glycolic acid peel remains a favorable first-line treatment in such populations.

KNOWLEDGE ATTITUDES AND PRACTICES OF MOTHER REGARDING CARE OF NEWBORN UMBILICAL CORD

S AMINA — 2025-07-11

Background: Appropriate umbilical cord care is critical in preventing neonatal morbidity and mortality. Maternal knowledge, attitudes, and practices (KAP) significantly influence cord care outcomes, yet gaps remain in many low- and middle-income countries. Objective: To assess the knowledge, attitudes, and practices of mothers regarding newborn umbilical cord care. Study Design: Cross-sectional study. Setting: Conducted in the Department of Pediatrics at GMC DHQ Hospital, Dera Ismail Khan, Pakistan. Duration of Study: 04-March-2024 to 04-September-2024. Methods: A total of 175 mothers of neonates aged 1–30 days were recruited through non-probability consecutive sampling. Data were collected using a structured questionnaire assessing maternal knowledge (13 items), attitudes (13 items), and practices. Scores were categorized as "high" (≥50%) or "low" (<50%). Data were analyzed using SPSS version 22. Chi-square test was applied, and a p-value <0.05 was considered statistically significant. Results: The mean age of neonates was 15.56 ± 8.73 days, and the mean maternal age was 28.77 ± 5.66 years. Overall, 62.2% of mothers demonstrated high knowledge and attitude scores, whereas only 21% had good practice scores. Higher maternal education level and socioeconomic status were significantly associated with better knowledge and practice scores (p < 0.05). Conclusion: While most mothers showed adequate knowledge and positive attitudes toward umbilical cord care, practices remained suboptimal. Community-based awareness and reinforcement programs are crucial for promoting hygienic cord care practices and reducing the risk of neonatal infections.

COMPARATIVE EFFICACY OF ORAL IVERMECTIN VERSUS SULPHUR OINTMENT (10%) IN SCABIES TREATMENT

MA SARWAR — 2025-07-14

Background: Scabies is a common parasitic skin infestation with significant public health impact, especially in resource-limited settings. Effective treatment is essential to reduce transmission and complications. While sulphur ointment is traditionally used, oral ivermectin has gained attention as a more convenient therapeutic option. Objective: To compare the efficacy of oral ivermectin with 10% sulphur ointment in the treatment of scabies. Study Design: Randomized controlled trial. Setting: Combined Military Hospital, Nowshera. Duration of Study: 27-November-2024 to 27-May-2025. Methods: Seventy-eight patients aged 15 to 50 years with clinically diagnosed scabies were randomly assigned to two equal groups. Group A received oral ivermectin (200 µg/kg) in two doses, one week apart. Group B applied 10% sulphur ointment topically for three consecutive nights. Patients were evaluated two weeks post-treatment. Treatment efficacy was defined as the absence of new lesions and complete healing of existing lesions, regardless of any residual nodules. Statistical analysis was conducted to compare outcomes between groups. Results: The mean age was 30.56 ± 10.40 years in the ivermectin group and 32.21 ± 11.02 years in the sulphur group. Treatment success was significantly higher in Group A (82.1%) compared to Group B (53.8%), with the difference being statistically significant (P = 0.008). Conclusion: Oral ivermectin demonstrated significantly higher efficacy than 10% sulphur ointment in treating scabies. It may be considered a more effective and patient-friendly alternative, particularly in clinical settings requiring rapid and reliable resolution of symptoms.

FREQUENCY OF H. PYLORI INFECTION IN FEMALE PATIENTS PRESENTING WITH CHOLELITHIASIS AT TERTIARY CARE HOSPITAL, LARKANA

A AHUJA — 2025-07-18

Background: Helicobacter pylori is a common gastrointestinal pathogen implicated in dyspepsia and peptic pathology. Its putative association with gallstone disease remains debated, with heterogeneous prevalence estimates across populations. Determining the burden of H. pylori among women with cholelithiasis can inform local diagnostic and management strategies. Objective: To determine the frequency of H. pylori infection in female patients presenting with cholelithiasis at a tertiary care hospital in Larkana, Pakistan. Study design: Cross-sectional, single-centre study. Settings: Department of Surgery, Chandka Medical College (tertiary care hospital), Larkana, Pakistan. Duration of study: January 5, 2025, to June 5, 2025. Methods: After institutional review board approval, consecutive non-probability sampling was used to enrol 79 women aged 30–60 years with newly diagnosed cholelithiasis and dyspeptic symptoms for ≥1 month. H. pylori infection status was determined according to institutional diagnostic protocols and recorded as present/absent. Stratified analyses were performed by age (<45 vs ≥45 years), residence (urban vs rural), and duration of dyspepsia (<6 months vs ≥6 months). Statistical significance was set at p<0.05. Results: The overall frequency of H. pylori infection was 25.3% (20/79). Infection prevalence was numerically higher in women <45 years (11/20) than in those ≥45 years (9/20), but the difference was not statistically significant (p=0.158). Residence was not associated with infection (urban 10/20 vs rural 10/20; p=1.0). Duration of dyspepsia showed no significant correlation with infection (≤6 months 10/20 vs >6 months 10/20; p=0.796). Conclusion: Among women with cholelithiasis at a tertiary centre in Larkana, H. pylori infection was moderate (~25%) and showed no significant association with age group, residence, or symptom duration. These data do not support routine stratification by these factors when considering H. pylori evaluation in this population.

FREQUENCY OF ACUTE KIDNEY INJURY IN NEONATES PRESENTING WITH PERINATAL ASPHYXIA IN TERTIARY CARE HOSPITAL

A WAKIL — 2025-07-14

Background: Perinatal asphyxia remains a significant cause of neonatal morbidity and mortality in developing countries. One of its serious complications is acute kidney injury (AKI), which contributes to poor outcomes if not promptly recognized and managed. Early detection of AKI in asphyxiated neonates is essential to reduce short- and long-term complications. Objective: To determine the frequency of acute kidney injury in neonates presenting with perinatal asphyxia in a tertiary care hospital. Study Design: Cross-sectional study. Setting: the pediatric department of Combined Military Hospital in Abbottabad, Pakistan. Duration of Study: 12-January-2025 to 12-May-2025. Methods: A total of 145 neonates aged 1–25 days with perinatal asphyxia, confirmed by an Apgar score <7 at 5 minutes, along with clinical signs, were included. Neonates were evaluated for acute kidney injury. AKI was defined by a serum creatinine level >1.5 mg/dL or a daily rise ≥0.2 mg/dL in the presence of oliguria. Data were analyzed to calculate the frequency of AKI, and results were expressed as mean ± SD for quantitative variables and percentages for categorical variables. Results: Among 145 neonates with perinatal asphyxia, 26 (17.9%) developed acute kidney injury. The mean serum creatinine level of the cohort was 1.42 ± 0.29 mg/dL. The mean age of neonates was 13.24 ± 6.87 days, with a male predominance (57.9%). Conclusion: The frequency of acute kidney injury in neonates with perinatal asphyxia was 17.9%. These findings highlight the need for routine renal function monitoring in neonates with asphyxia to ensure early detection and timely management of AKI.

FREQUENCY OF DIFFERENT PRESENTATIONS IN MYOCARDIAL INFARCTION PATIENTS WITH AND WITHOUT DIABETES

S KHAN — 2025-07-10

Background: Myocardial infarction (MI) presents with a spectrum of symptoms, and diabetic patients often exhibit atypical or less pronounced presentations, which may delay diagnosis and treatment. Understanding the variation in symptomatology between diabetic and non-diabetic patients is essential for timely intervention. Objective: To determine the frequency of various clinical presentations of myocardial infarction and compare symptom patterns between diabetic and non-diabetic patients. Study Design: Cross-sectional observational study. Setting: Cardiology Department, Rehman Medical Institute, Peshawar. Duration of Study: From February 23, 2025, to May 23, 2025. Methods: A total of 164 patients (both diabetic and non-diabetic), aged 35 to 90 years, and diagnosed with MI were included. Clinical symptoms such as chest pain, arm pain, epigastric pain, jaw pain, nausea/vomiting, anxiety, and cold sweats were recorded and compared between the diabetic and non-diabetic groups. Data were analysed using descriptive statistics and Chi-square tests, with a p-value <0.05 considered statistically significant. Results: The mean age of participants was 65.7 ± 16.47 years, with males comprising 56.7% of the cohort. Chest pain was the most commonly reported symptom (72%). Diabetic patients had a significantly higher frequency of epigastric pain (16.5%, p = 0.03), anxiety (32.9%, p = 0.01), and cold sweats (43.0%, p = 0.04) compared to non-diabetics. Other symptoms, such as arm pain, jaw pain, and nausea/vomiting, showed no statistically significant differences between the two groups. Conclusion: Chest pain remains the predominant presenting symptom in both diabetic and non-diabetic MI patients. However, diabetic patients are more likely to present with atypical symptoms such as epigastric pain, anxiety, and cold sweats. These findings underscore the need for heightened clinical suspicion and broader diagnostic criteria when assessing diabetic patients for MI.

EFFICACY OF INTRADERMAL MICRO INJECTION OF TRANEXAMIC ACID VS ORAL TRANEXAMIC ACID FOR THE TREATMENT OF MELASMA

K BIBI — 2025-07-19

Background: Melasma is a common acquired hyperpigmentation disorder that significantly affects quality of life. Tranexamic acid (TXA) has recently emerged as a promising therapeutic option, administered via different routes including oral and intradermal delivery. However, comparative evidence regarding their relative efficacy remains limited. Objective: To compare the efficacy of intradermal microinjection of tranexamic acid with oral tranexamic acid in the treatment of melasma. Study Design: A randomized controlled trial. Setting: Department of Dermatology, Combined Military Hospital, Nowshera, Pakistan. Duration of Study: 11-October-2024 to 11-April-2025. Methods: A total of 62 patients with clinically diagnosed melasma were enrolled and allocated equally into two groups. Group A received intradermal TXA microinjections at three-week intervals for five sessions, while Group B received oral TXA 250 mg twice daily for 12 weeks. The primary outcome was the proportion of patients achieving treatment efficacy, assessed by [insert scale used, e.g., MASI reduction if available]. Statistical analysis was performed using the Chi-square test, with a p-value of ≤ 0.05 considered statistically significant. Results: The mean age in Group A was 31.61 ± 11.37 years and in Group B 31.48 ± 10.94 years. A significantly higher proportion of patients in the intradermal TXA group achieved efficacy (64.5%, n = 20) compared with the oral TXA group (29.0%, n = 9) (p = 0.005). Conclusion: Intradermal tranexamic acid microinjections demonstrated significantly superior efficacy compared to oral tranexamic acid in the treatment of melasma. These findings suggest that intradermal administration may be the preferred therapeutic option for achieving optimal clinical outcomes.

FREQUENCY OF HYPONATREMIA IN ADULT PATIENTS WITH BACTERIAL MENINGITIS: A CROSS-SECTIONAL STUDY

IA SHAH — 2025-07-14

Background: Hyponatremia is a common electrolyte imbalance observed in central nervous system infections, including bacterial meningitis. It can worsen neurological status and clinical outcomes if left unrecognized and untreated. Objective: To determine the frequency of hyponatremia in adult patients diagnosed with bacterial meningitis. Study Design: Cross-sectional study. Setting: the General Medicine Department of Mufti Mehmood Memorial Teaching Hospital, MTI, Gomal Medical College, Dera Ismail Khan, Pakistan. Duration of Study: The study time frame was 02-Novemeber-2024 to 02-May-2025. Methods: A total of 135 adult patients aged 18–60 years with confirmed bacterial meningitis were enrolled. Diagnosis was based on clinical signs (fever ≥38.5°C, nuchal rigidity, photophobia) and cerebrospinal fluid (CSF) analysis (WBC >1,000 cells/μL or glucose <40 mg/dL). Hyponatremia was defined as serum sodium ≤130 mEq/L with associated clinical symptoms (e.g., nausea, vomiting, confusion). Data were analyzed using descriptive statistics with SPSS, and categorical variables were expressed in percentages. Results: The mean age of participants was 40.13 ± 12.72 years, with 57.8% being male and 42.2% female. Comorbidities included hypertension (31.9%) and diabetes mellitus (21.5%). Hyponatremia was identified in 54.8% of the study population. Conclusion: Hyponatremia was observed in more than half of the patients with bacterial meningitis, highlighting its high frequency and clinical relevance. Routine electrolyte monitoring and prompt correction may improve outcomes in these patients.

COMPARISON OF FERROUS SULPHATE AND IRON POLYMALTOSE COMPLEX IN CHILDREN FOR THE TREATMENT OF IRON DEFICIENCY ANEMIA

M AMJAD — 2025-07-16

Background: Iron deficiency anemia (IDA) is the most common nutritional deficiency in children worldwide. Oral iron therapy remains the cornerstone of treatment, with ferrous sulphate and iron polymaltose complex (IPC) commonly prescribed. However, their comparative efficacy remains a matter of debate. Objective: To compare the effectiveness of ferrous sulphate and iron polymaltose complex in children for the treatment of IDA. Study Design: Randomized controlled trial. Setting: Department of Pediatrics at Saidu Group of Teaching Hospitals, Swat, Pakistan. Duration of Study: 21 July 2024 to 21 January 2025. Methods: A total of 72 children aged 2–10 years with confirmed IDA were enrolled and randomly allocated into two equal groups. Group A received oral ferrous sulphate at 6 mg/kg/day, while Group B was administered an equivalent dose of IPC. Treatment efficacy was defined as achieving a hemoglobin level of≥10.5 g/dL and a serum ferritin level of>15 ng/mL after four weeks of therapy. Data were analyzed using SPSS version 25, and the chi-square test was applied; P < 0.05 was considered statistically significant. Results: The mean age of children in Group A was 5.42 ± 2.51 years, while in Group B it was 6.47 ± 2.36 years. Treatment efficacy was achieved in 88.9% of children in the ferrous sulphate group compared to 63.9% in the IPC group (P = 0.01). Conclusion: Ferrous sulphate was significantly more effective than iron polymaltose complex in improving hematological parameters among children with IDA, supporting its role as the preferred first-line oral therapy.

COMPARATIVE STUDY OF EFFICACY OF LOW-DOSE CONTINUOUS AND LOW-DOSE INTERMITTENT ORAL ISOTRETINOIN THERAPY IN MODERATE ACNE VULGARIS

N NOOR — 2025-07-19

Background: Acne vulgaris is a common dermatological condition that significantly affects quality of life. Isotretinoin is the most effective treatment for moderate-to-severe cases. Still, concerns regarding dosing strategies and adverse effects have led to investigations into alternative regimens such as low-dose continuous and intermittent therapies. Objective: To compare the efficacy of low-dose continuous and low-dose intermittent oral isotretinoin therapy in patients with moderate acne vulgaris. Study Design: Quasi-experimental design. Setting: Department of Dermatology, Combined Military Hospital, Nowshera, Pakistan. Duration of Study: 08-February-2025 to 08-June-2025. Methods: A total of 112 participants aged 18–60 years with clinically diagnosed moderate acne vulgaris were enrolled and equally allocated into two groups (n=56 each). Group A received continuous oral isotretinoin (20 mg once daily for 2 months), while Group B received intermittent oral isotretinoin (20 mg once daily for 1 week per 4-week cycle over 2 months). Efficacy was defined as at least a 10-point reduction in Global Acne Grading System (GAGS) score from baseline to 2 months. An independent t-test was applied to compare pre- and post-treatment GAGS scores, with a significance threshold set at p ≤ 0.05. Results: The mean age of participants was 30.71 ± 10.13 years in Group A and 29.43 ± 8.55 years in Group B. Following treatment, mean GAGS scores were 10.43 ± 5.53 in Group A and 8.75 ± 5.99 in Group B. No statistically significant difference was observed between the groups (p = 0.12). Both regimens demonstrated clinically meaningful improvement. Conclusion: Low-dose continuous and low-dose intermittent oral isotretinoin therapies are similarly effective for the management of moderate acne vulgaris. Both regimens can be considered safe and effective alternatives in clinical practice.

ASSESSING FUNCTIONAL OUTCOMES OF ARTHROSCOPIC PARTIAL MENISCECTOMY IN MIDDLE-AGED ADULTS WITH MENISCAL TEARS

SA RAHIM — 2025-07-19

Background: Meniscal tears are a frequent cause of knee pain and disability in middle-aged adults. Arthroscopic partial meniscectomy (APM) is widely performed, yet its functional outcomes in this age group remain debated. Local evidence is essential to optimize treatment selection and patient counseling. Objective: To determine the functional outcome of arthroscopic partial meniscectomy in middle-aged adults with meniscal tears. Study Design: Descriptive study. Setting: The Orthopedic Surgery Department of Combined Military Hospital, Peshawar, Pakistan. Duration of Study: 27-Nov-2024 to 27-May-2025. Methods: A total of 87 patients aged 40–70 years with symptomatic meniscal tears were included. All patients underwent standardized arthroscopic partial meniscectomy. Functional outcomes were assessed 12 weeks postoperatively using the Lysholm knee scoring scale and categorized as excellent (95–100), good (84–94), fair (65–83), or poor (<65). Descriptive statistics (mean ± SD, frequencies, percentages) were computed using SPSS 25. Results: The mean age of participants was 54.31 ± 8.67 years, with a slight male predominance (56.3%). Degenerative tears were more common (71.3%) compared to traumatic tears (28.7%). Postoperative functional outcomes were excellent in 33 (37.9%) patients, good in 31 (35.6%), fair in 21 (24.1%), and poor in 2 (2.3%). Conclusion: Arthroscopic partial meniscectomy demonstrated favorable short-term functional outcomes in middle-aged adults with meniscal tears, with nearly three-quarters achieving good-to-excellent results. Careful patient selection remains key, particularly in degenerative cases.

FREQUENCY OF RESTLESS LEGS SYNDROME IN PATIENTS WITH PARKINSON'S DISEASE PRESENTING AT FOUJI FOUNDATION HOSPITAL, RAWALPINDI

N ULLAH — 2025-07-10

Background: Restless Legs Syndrome (RLS) is a common non-motor symptom in patients with Parkinson's disease (PD) that significantly affects quality of life. Its prevalence varies and may be influenced by factors such as medication, disease duration, and comorbidities. Objective: To determine the frequency of Restless Legs Syndrome in patients with Parkinson's disease. Study Design: cross-sectional study. Setting: The Department of Neurology at Fouji Foundation Hospital, Rawalpindi, Pakistan. Duration of Study: 12 September 2024 to 12 March 2025. Methods: A total of 73 patients with clinically diagnosed Parkinson's disease aged 40–80 years were enrolled. RLS was diagnosed based on the International Restless Legs Syndrome Study Group (IRLSSG) criteria, and symptom severity was evaluated using the International RLS Rating Scale (IRLS). Parkinson's disease severity was assessed using the Hoehn and Yahr scale. Data on demographics, comorbidities, medication use, and disease characteristics were collected using a structured proforma. Results: The mean age of participants was 63.96 ± 11.15 years, with a mean PD duration of 5.18 ± 2.00 years. Males accounted for 56.2% of the cohort. RLS was identified in 20.5% of the patients, and 27.4% were receiving dopaminergic therapy. Common comorbid conditions included hypertension (46.6%) and diabetes mellitus (30.1%). Conclusion: This study found a moderately high frequency (20.5%) of Restless Legs Syndrome in patients with Parkinson's disease. These findings underscore the importance of routine screening for RLS in PD patients to improve overall disease management and quality of life.

FREQUENCY OF HEPATITIS C SEROPOSITIVITY AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS

T TAJ — 2025-09-29

Background: Hepatitis C virus (HCV) infection remains a global health burden, with an increased risk of chronic complications in patients with comorbidities. Type 2 diabetes mellitus (T2DM) has been associated with higher HCV prevalence, potentially due to shared risk factors and the impact of chronic HCV on glucose metabolism. Objective: To determine the frequency of hepatitis C seropositivity among patients with type 2 diabetes mellitus. Study Design: Cross-sectional study. Setting: Department of Medicine, Tertiary Care Hospital, Peshawar. Duration of Study: January 2025 to July 2025. Methods: A total of 178 patients, aged 21–70 years and of either gender, with a diagnosed type 2 diabetes mellitus, were enrolled. Patients with other liver diseases, renal disease, or cardiac disease were excluded from the study. Blood samples were collected and tested for HCV seropositivity using standard serological assays. Data were analyzed using SPSS version 23. Results: The mean age of the study population was 55.63 ± 9.46 years. Among the patients, 103 (57.9%) were female and 75 (42.1%) were male. The overall frequency of HCV seropositivity in type 2 diabetic patients was 27 (15.2%). Conclusion: The frequency of hepatitis C seropositivity in patients with type 2 diabetes mellitus was found to be 15.2%. This highlights the importance of routine HCV screening in diabetic populations to facilitate early diagnosis and management.

INDICATIONS OF CAESAREAN SECTION IN WOMEN PRESENTING AT COMBINED MILITARY HOSPITAL KOHAT

S KHAN — 2025-07-14

Background: Caesarean section (C-section) is one of the most frequently performed surgical procedures in obstetrics and gynecology worldwide. While it can be life-saving for both mother and child, rising global rates have raised concerns regarding appropriate indications. Identifying the most common indications is essential for optimizing obstetric care and reducing unnecessary procedures. Objective: To determine the indications of caesarean section among women presenting at the Combined Military Hospital (CMH) Kohat. Study Design: Descriptive cross-sectional study. Setting: Department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Kohat, Pakistan. Duration of Study: 04-March-2024 to 04-September-2024. Methods: A total of 158 pregnant women aged 18–40 years undergoing caesarean section were included. Indications for C-section were assessed, including fetal distress (abnormal fetal heart rate >160 or <120 beats/minute), non-progress of labor (prolonged labor >20 hours), and breech presentation (fetal position with buttocks or feet down). Data were analyzed using descriptive statistics; categorical variables were expressed as frequencies and percentages, and mean ± SD was calculated for continuous variables. Results: The mean age of participants was 26.99 ± 6.81 years. Fetal distress was the most frequent indication for C-section (38.6%), followed by non-progress of labor (32.9%), and breech presentation (28.5%). Conclusion: Fetal distress emerged as the leading indication for caesarean section in this study, followed by non-progress of labor and breech presentation. These findings underscore the importance of timely intrapartum monitoring and effective labor management strategies to reduce avoidable caesarean deliveries.

MICROBIAL ETIOLOGY AND ANTIBIOTIC RESISTANCE IN SURGICAL SITE INFECTIONS: IMPLICATIONS FOR OBSERVATIONAL TREATMENT

M NOMAN — 2025-09-07

Background: Surgical site infections (SSIs) remain a major contributor to postoperative morbidity, prolonged hospitalization, and increased healthcare costs. Rising antimicrobial resistance (AMR) among causative pathogens further complicates treatment, underscoring the need for local microbiological surveillance to guide empirical therapy. Objective: To determine the microbial etiology and antimicrobial susceptibility patterns of pathogens isolated from SSIs in postoperative patients. Study Design: Observational cross-sectional study. Setting: Department of Pathology, Allied Hospital, Faisalabad, Pakistan. Duration of Study: July 2022 to December 2022. Methods: A total of 100 wound swabs and pus specimens were collected from adult patients in surgical and orthopedic wards with clinically suspected SSIs. Samples were processed using standard microbiological protocols, and isolates were identified through biochemical testing. Antimicrobial susceptibility was evaluated using the Kirby–Bauer disk diffusion method, following CLSI guidelines. Data were analyzed with SPSS version 17.0. Results: Of the 100 bacterial isolates, 45% were Gram-positive and 55% were Gram-negative organisms. Staphylococcus aureus was the most frequent pathogen (43%), followed by Escherichia coli (36%), Pseudomonas spp. (9%), Proteus spp. (4%), and Klebsiella spp. (3%). S. aureus demonstrated high resistance to penicillin (88%) and ampicillin (82%) but remained fully susceptible to vancomycin (100%) and highly sensitive to linezolid (98%) and amikacin (90%). Gram-negative isolates showed high resistance to ampicillin (96.7%) and cotrimoxazole (93.3%), while colistin (100%), amikacin (88.3%), and meropenem (81%) were the most effective agents. Conclusion: S. aureus and E. coli were the predominant pathogens in SSIs, both exhibiting high resistance to first-line antibiotics. Culture-guided therapy, reinforced infection control practices, and continuous antimicrobial surveillance are critical to improving SSI management and combating AMR in surgical settings.

COMPARATIVE EFFICACY OF CRYOTHERAPY AND INTRALESIONAL VITAMIN D3 IN PATIENTS WITH PLANTAR WARTS

SM BILLAH — 2025-07-14

Background: Plantar warts, caused by human papillomavirus (HPV), are common and often resistant to treatment. While cryotherapy is a standard approach, intralesional vitamin D3 has emerged as a newer, immunomodulatory option. Comparative evidence regarding their efficacy remains limited. Objective: To compare the efficacy of cryotherapy and intralesional vitamin D3 in the treatment of plantar warts. Study Design: randomized controlled trial. Setting: Combined Military Hospital (CMH), Nowshera. Duration of Study: 02-December-2024 to 02-June-2025. Methods: A total of 194 patients aged 15–45 years presenting with 1–3 plantar warts were enrolled and randomly assigned to two groups. Group A (n = 97) received cryotherapy using liquid nitrogen biweekly for six weeks. Group B (n = 97) received intralesional vitamin D3 (0.2 mL of 7.5 mg/mL) at the same interval. Treatment efficacy was defined as complete clinical clearance of all warts by six weeks. Statistical analysis was performed using a chi-square test; p-value <0.05 was considered significant. Results: The mean age was 31.55 ± 9.35 years in Group A and 32.23 ± 8.37 years in Group B. Cryotherapy showed a significantly higher clearance rate of 66.0% compared to 45.4% with intralesional vitamin D3 (p = 0.004). Conclusion: Cryotherapy is considerably more effective than intralesional vitamin D3 in achieving complete resolution of plantar warts over six weeks, and should be preferred as a first-line treatment in clinical practice.

COMPARISON OF RED CELL INDICES IN IRON DEFICIENCY ANEMIA AND BETA THALASSEMIA MINOR IN CHILDREN AGE 6 MONTHS TO 2 YEARS

G KHAN — 2025-07-17

Background: Iron deficiency anemia (IDA) and β-thalassemia trait (β-TT) are the most common microcytic hypochromic anemias in children. Distinguishing between these conditions is essential for accurate management and genetic counseling, especially in resource-limited settings where advanced diagnostic testing may not be readily available. Red cell indices provide a simple and cost-effective method for differentiating between red blood cells. Objective: To determine and compare mean red cell indices in children aged 6 months to 2 years with iron deficiency anemia and β-thalassemia minor. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Unit-C of Khyber Teaching Hospital, Peshawar, Pakistan. Duration of Study: 21-October-2024 to 21-April-2025. Methods: A total of 60 children aged 6 months to 2 years were enrolled, including 30 with IDA and 30 with β-TT. Children were classified as IDA if hemoglobin was <13 g/dL with serum ferritin <10 ng/mL, and as β-TT if hemoglobin was <13 g/dL with HbA2 >7%. Venous blood samples were analyzed for hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), and red blood cell (RBC) count. Statistical analysis was performed using SPSS (version [insert]), with p < 0.05 considered significant. Results: The mean MCV was significantly higher in IDA (75.04 ± 2.06 fL) compared to β-TT (72.89 ± 1.77 fL; p < 0.0001). MCHC was lower in IDA (31.59 ± 1.49 g/dL) than in β-TT (34.44 ± 1.13 g/dL; p < 0.0001). RDW was markedly elevated in β-TT (19.39 ± 1.71%) compared to IDA (14.32 ± 1.64%; p < 0.0001). RBC counts were higher in β-TT (4.90 ± 0.98 ×10⁶/μL) compared to IDA (4.06 ± 0.62 ×10⁶/μL; p < 0.0001). Conclusion: Red cell indices, including MCV, MCHC, RDW, and RBC count, demonstrated significant differences between IDA and β-TT. These findings support their role as simple, reliable, and cost-effective discriminators in differentiating between the two conditions in pediatric populations.

COMPARISON OF VITAMIN E AND URSODEOXYCHOLIC ACID IN NON-ALCOHOLIC STEATOHEPATITIS (NASH)

M AMIN — 2025-07-20

Background: Non-alcoholic steatohepatitis (NASH) is a progressive phenotype of non-alcoholic fatty liver disease characterized by hepatocellular injury, elevated transaminases, and a substantive risk of fibrosis progression. Antioxidant therapy (vitamin E) and bile acid–based therapy (ursodeoxycholic acid, UDCA) are commonly used, yet their short-term comparative biochemical effectiveness remains uncertain. Objective: To compare the effectiveness of vitamin E versus UDCA in reducing serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels over eight weeks in adults with NAFLD/NASH. Study design: Randomized controlled trial. Settings: Department of Medicine, Sir Ganga Ram Hospital, Lahore, Pakistan. Duration of study: 22 March 2025 to 22 June 2025. Methods: Ninety adult patients with NAFLD/NASH were randomized into two groups: UDCA 15 mg/kg/day or vitamin E 200 IU/day for eight weeks. Liver function tests (ALT, AST, alkaline phosphatase (ALP), total bilirubin, albumin) were recorded at baseline and eight weeks. Between-group comparisons of mean change from baseline were assessed using the Student's t-test with two-sided α=0.05.Results: Both interventions produced significant within-group reductions in ALT and AST at eight weeks. Vitamin E achieved greater mean reductions than UDCA in ALT (31.5 vs 25.2 U/L; p=0.002) and AST (27.6 vs 22.6 U/L; p=0.001). A significant decrease in ALP was also observed in the vitamin E group, whereas changes in total bilirubin and albumin were minimal in both groups. Conclusion: Over eight weeks, vitamin E produced larger reductions in serum transaminases than UDCA in adults with NAFLD/NASH, with additional improvement in ALP. Vitamin E may be preferred for short-term biochemical optimization in NASH, pending confirmation in longer-duration trials with histological endpoints.

ASSESSMENT OF MORPHOLOGICAL PARAMETERS DEFINING RISK STRATIFICATION IN CUTANEOUS BASAL CELL CARCINOMA. A SINGLE-CENTRE STUDY

M FATIMA — 2025-07-14

Background: Basal cell carcinoma (BCC) is the most common skin malignancy worldwide, yet its clinical risk is heterogeneous and strongly influenced by histomorphological features. Data from Pakistan are limited, and local evidence is needed to inform treatment strategies based on histology-defined risk. Objective: To evaluate histomorphological parameters for risk stratification in cutaneous basal cell carcinoma in a Pakistani population. Study Design: Single-centre observational study. Setting: Department of Histopathology, Chughtai Lab, Pakistan. Duration of Study: 1 March 2023 to 30 September 2024. Methods: Histopathology reports of 382 unique BCC specimens were retrieved from the laboratory information system (Nexus Pro). Extracted variables included age, gender, anatomical site, and maximum tumor diameter. Histological subtypes were categorized as nodular, infiltrative, superficial, keratotic, adenoid, micronodular, or mixed. Depth of invasion was measured from the reconstructed epidermal surface to the deepest tumor nest and stratified into clinically relevant groups. Adverse features, including perineural invasion (PNI), lymphovascular invasion (LVI), and ulceration, were documented. High-risk histology was defined a priori as any infiltrative or micronodular component (pure or mixed). Descriptive statistics were performed in line with STROBE guidance. Results: The mean age was 63.11 ± 14.48 years; 50.5% were female, and 63.9% were ≥60 years. The majority of lesions arose on the head and neck. Nodular BCC was the most common pure subtype (62.3%), followed by infiltrative (19.9%) and superficial (7.9%); mixed subtypes constituted 7.3%. Depth of invasion was ≥7 mm in 52.4% of tumors, while 36.2% measured ≥20 mm clinically. Adverse features included PNI in 6.5%, LVI in 0.5%, and ulceration in 86.9%. Overall, 25.1% of cases were classified as high-risk and 74.9% as low-risk histology. Conclusion: Nodular BCC was the predominant subtype, but one in four tumors exhibited high-risk histology. A substantial proportion of lesions were large (≥20 mm) or deeply invasive (≥7 mm) at presentation. Morphology-based risk stratification is practical for routine reporting and can inform surgical margins, surveillance intensity, and multidisciplinary referral decisions. Early detection, particularly for head and neck lesions, may reduce the burden of advanced disease.

PREVALENCE OF SEXUAL DYSFUNCTION AMONG WOMEN OF REPRODUCTIVE AGE GROUP WITH TYPE 2 DIABETES MELLITUS AT THE ENDOCRINOLOGY AND DIABETES UNIT, LADY READING HOSPITAL, PESHAWAR

UES RASHID — 2025-07-14

ABSTRACT

Background: Sexual dysfunction in women is a commonly overlooked complication of type 2 diabetes mellitus (T2DM), impacting physical and emotional well-being. It is particularly relevant among women of reproductive age, where quality of life and relational health may be significantly affected. Objective: To determine the prevalence of sexual dysfunction among women of reproductive age with T2DM and explore associated demographic and clinical factors. Study Design: Cross-sectional study. Setting: Conducted at a tertiary care center (Department of Diabetes and Endocrinology, Lady Reading Hospital, Peshawar, Pakistan). Duration of Study: 19 October 2024 to 19 April 2025. Methods: A total of 245 women aged 18 to 45 years with T2DM were enrolled. Data were collected using a structured demographic questionnaire and the validated Female Sexual Function Index (FSFI), which evaluates six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. Statistical analysis was performed to determine prevalence and assess associations (p<0.05 considered significant). Results: The overall prevalence of sexual dysfunction was 62.0%. Dysfunction was significantly higher among uneducated women (61.8%, p<0.05), those residing in rural areas (65.8%, p<0.05), women with a diabetes duration >5 years (59.9%, p<0.05), and those with obesity (19.1%, p<0.05). Conclusion: Sexual dysfunction was found to be prevalent in 62% of women of reproductive age with T2DM. Lower education, rural residence, longer duration of diabetes, and obesity were significantly associated with increased risk. These findings emphasize the need for routine sexual health screening and counseling in diabetic care for women.

FREQUENCY OF FACIAL NERVE PALSY IN BASE OF SKULL FRACTURES

MS KHAN — 2025-07-17

Background: Early recognition through standardized clinical and radiological evaluation is essential for timely management. Objective: To establish the frequency and clinical-radiological characteristics of FNP among patients presenting with skull base fractures, using a standardized diagnostic protocol. Study Design: Cross-sectional study. Setting: Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: 29-December-2024 to 29-May-2025. Methods: Adult patients (18–65 years) with CT-confirmed skull base fractures were consecutively enrolled. Patients with Glasgow Coma Scale (GCS) <8 or penetrating craniocerebral injuries were excluded. FNP was defined by acute unilateral facial weakness plus associated symptoms, supported by MRI evidence of neural injury. Clinical grading was performed using the House-Brackmann scale. Data were analyzed using SPSS version 26. Results: Out of 165 screened patients, 143 met the inclusion criteria. The mean age was 36.8 ± 12.5 years, with a male predominance (79.0%). Road traffic accidents were the most common cause (66.4%). The overall frequency of FNP was 7.0% (10/143; 95% CI: 3.4–12.5%). Of these, 70% presented with an acute onset, and 30% with a delayed onset. At presentation, 60% had complete paralysis (House-Brackmann Grade VI) and 40% had incomplete paralysis. MRI confirmed nerve injury in all cases, while CT demonstrated bony impingement in only one patient. Conclusion: The frequency of FNP in skull base fracture patients was 7.0%, most commonly presenting as acute, complete paralysis. MRI showed superior diagnostic yield over CT in confirming neural injury, highlighting its vital role in the evaluation and management of skull base trauma.

A COMPARATIVE ANALYSIS OF EFFICACY AND SAFETY OF PREGABALIN VERSUS DULOXETINE IN MANAGING DIABETIC NEUROPATHY

K GUL — 2025-07-18

Background: Diabetic neuropathy is a common complication of diabetes mellitus, often leading to significant morbidity and impaired quality of life. Pharmacological management includes agents such as pregabalin and duloxetine, but comparative evidence on their efficacy and safety remains limited in local populations. Objective: To compare the efficacy and safety of pregabalin versus duloxetine in the management of diabetic neuropathy at Lady Reading Hospital, Peshawar. Study Design: Randomized controlled trial. Setting: Department of Medicine, Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: 05-December-2024 to 05-June-2025. Methods: A total of 160 patients aged 30–75 years with confirmed diabetes mellitus and clinically diagnosed diabetic neuropathy were randomly assigned to two equal groups. Group A received pregabalin (300 mg/day) and Group B received duloxetine (60 mg/day). Efficacy was evaluated by improvement in neuropathic symptoms and physical examination findings. Safety was assessed based on the occurrence of adverse events, including constipation, decreased appetite, and lethargy. Statistical analysis was performed using SPSS version 25, with chi-square and t-tests applied as appropriate; p-values <0.05 were considered statistically significant. Results: In the duloxetine group, 77.5% of patients achieved symptomatic improvement compared to 61.2% in the pregabalin group (p < 0.05). Adverse event profiles were comparable between the two groups. Pregabalin was associated with a higher incidence of lethargy (11.2%), while duloxetine had slightly more cases of constipation (7.5%), with no statistically significant difference (p > 0.05). Conclusion: Duloxetine demonstrated significantly greater efficacy than pregabalin in managing diabetic neuropathy, while both drugs exhibited similar safety profiles. Duloxetine may be considered a preferred option in this patient population.

FUNCTIONAL OUTCOME OF ACETABULUM FRACTURE MANAGED WITH OPEN REDUCTION AND INTERNAL FIXATION

MT KHAN — 2025-07-17

Background: Acetabular fractures represent a complex orthopedic challenge due to their association with high-energy trauma and potential for long-term disability. Open reduction and internal fixation (ORIF) remain the standard treatment, aiming to restore joint congruency and optimize functional outcomes. Objective: To determine the functional outcome of acetabular fractures managed with open reduction and internal fixation (ORIF). Study Design: Descriptive study. Setting: The Department of Orthopedic Surgery at Hayatabad Medical Complex in Peshawar, Pakistan. Duration of Study: 22-12-2024 to 22-05-2025.Methods: A total of 65 patients aged 18–65 years with radiologically and clinically confirmed acetabular fractures were included. All patients underwent ORIF via surgical approaches tailored to their fracture pattern. Functional outcome was assessed three months postoperatively using the Oxford Hip Score (OHS), categorizing results as excellent (41–48), good (34–40), fair (27–33), or poor (0–26). Data were analyzed to determine the distribution of outcomes according to fracture type and patient demographics. Results: The mean age was 45.12 ± 13.99 years, with a male predominance (64.6%). The most frequent fracture type was both-column (38.5%), followed by posterior wall (36.9%). At three-month follow-up, outcomes were excellent in 44 patients (67.7%), good in 17 (26.2%), and fair in 4 (6.2%). No poor outcomes were observed. Conclusion: ORIF for acetabular fractures demonstrated favorable short-term functional outcomes, with 67.7% of patients achieving excellent and 26.2% good results at three months. These findings support ORIF as an effective strategy for restoring hip function in patients with acetabular fractures.

ASSESSMENT OF THE ASSOCIATION OF PREDICTORS OF MORTALITY IN MECHANICALLY VENTILATED PATIENTS

A KARAMAT — 2025-07-14

Background: Mechanically ventilated patients constitute a high-risk population in intensive care units (ICUs), where a combination of clinical, physiological, and demographic variables frequently determines mortality. Early identification of these predictors is critical to inform therapeutic strategies and improve survival outcomes. Objective: To determine the association of clinical, physiological, and demographic parameters with mortality among patients receiving invasive mechanical ventilation in a tertiary care ICU in Pakistan. Study Design: Descriptive cross-sectional study. Settings: Chest Intensive Care Unit, Gulab Devi Teaching Hospital, Lahore, Pakistan. Duration of Study: August 2023 to January 2024. Methods: A total of 60 adult patients (aged <70 years) who underwent invasive mechanical ventilation were enrolled through non-probability convenience sampling. Demographic characteristics, comorbidities, clinical diagnosis, and indications for intubation were recorded. Post-intubation parameters—including arterial pH, PaO₂/FiO₂ ratio, and Richmond Agitation-Sedation Scale (RASS) scores—were analyzed. The primary endpoint was in-hospital mortality. Statistical analysis was performed using SPSS version 26, with a significance threshold of p<0.05. Results: The in-hospital mortality rate was 75% (n=45), while 25% (n=15) of patients were successfully extubated. No significant correlation was found between mortality and demographic factors such as age (p=0.257), gender (p=0.620), or weight (p=0.389). However, significant predictors of mortality included the underlying reason for intubation (p=0.019), particularly low Glasgow Coma Scale scores and cardiac arrest. Comorbid conditions such as diabetes mellitus (p=0.015) and cardiac disease (p=0.030) were also significantly associated with mortality. Moreover, post-intubation arterial pH (p=0.021), PaO₂/FiO₂ ratio (p=0.021), and RASS scores (p=0.000) demonstrated strong associations with adverse outcomes. Conclusion: The etiology of intubation, pre-existing comorbidities, and early post-intubation physiological parameters significantly influence mortality among mechanically ventilated patients. Proactive recognition and targeted management of these predictors may enhance survival outcomes in critically ill ventilated patients.

FREQUENCY OF SEROMA FORMATION IN PATIENTS UNDERGOING LICHTENSTEIN REPAIR FOR INGUINAL HERNIA

A REHMAN — 2025-07-14

Background: Lichtenstein mesh hernioplasty is the most widely performed surgical technique for inguinal hernia repair. Postoperative seroma formation remains a frequent complication that can affect recovery and patient outcomes. Objective: To determine the frequency of seroma formation in patients undergoing Lichtenstein repair for inguinal hernia. Study Design: Descriptive study. Setting: Department of Surgery, Saidu Group of Teaching Hospital, Pakistan. Duration of Study: 13-August-2024 to 13-February-2025. Methods: A total of 120 patients with inguinal hernia were enrolled using consecutive non-probability sampling. All patients underwent Lichtenstein mesh hernioplasty under general anaesthesia. Seroma formation was assessed within 30 days postoperatively, defined by pain (VAS > 3), tenderness, and a palpable fluid collection that discharged clear fluid on examination. Data analysis was performed using SPSS version 27. Results: The mean age of patients was 46.17 ± 13.84 years, with 113 (94.2%) males and 7 (5.8%) females. Seroma formation occurred in 9.2% of patients. No significant association was found between seroma and any of the demographic or clinical variables, including age, gender, BMI, hypertension, smoking, or socioeconomic status. However, a significant association was observed between diabetes mellitus and seroma formation (p < 0.05). Conclusion: Seroma formation was observed in 9.2% of patients following Lichtenstein repair for inguinal hernia. Diabetes mellitus was significantly associated with an increased risk of seroma, highlighting the need for careful perioperative management in diabetic patients.

COMPARISON OF EFFICACY OF 40MG VERSUS 80MG METHYLPREDNISOLONE EPIDURAL INJECTION IN TREATMENT OF LOW BACK PAIN WITH RADICULOPATHY

SA KHAN — 2025-07-14

Background: Low back pain with radiculopathy is a common cause of disability worldwide. Epidural steroid injections (ESIs) are frequently employed for symptom relief, but the optimal steroid dosage for maximum efficacy and safety remains uncertain. Objective: To compare post-treatment Visual Analogue Scale (VAS) scores between 40 mg and 80 mg methylprednisolone epidural injections in patients with low back pain and radiculopathy. Study Design: Randomized controlled trial. Setting: The study was conducted in the Department of Orthopedics at Lady Reading Hospital, Peshawar. Duration: 4 May 2024 to 4 November 2024. Methods: A total of 212 patients diagnosed with low back pain and radiculopathy were randomly assigned to two equal groups. Group A received 40 mg methylprednisolone and Group B received 80 mg methylprednisolone, both administered transforaminally via epidural injection. VAS scores were recorded at baseline and 4 weeks post-intervention. Statistical significance was set at p<0.05. Results: A significantly greater reduction in VAS scores was observed in Group A compared to Group B (p<0.05). Subgroup analysis, stratified by comorbidity status, showed consistent results. Conclusion: A 40 mg methylprednisolone epidural injection provides superior short-term pain relief compared to 80 mg, with potential advantages in safety and cost-effectiveness.

ASSOCIATION OF ANXIETY AND DEPRESSIVE SYMPTOMS WITH HYPOTHYROIDISM

S RAZAQ — 2025-07-19

Background: Hypothyroidism is a common endocrine disorder frequently associated with psychiatric manifestations. Depression and anxiety are among the most reported symptoms, significantly affecting patients' quality of life. Understanding this association is crucial for early diagnosis and holistic management. Objective: To establish the relationship between anxiety, depression, and hypothyroidism. Study Design: Cross-sectional study. Setting: Hayatabad Medical Complex, Peshawar, Pakistan. Duration of Study: 10-09-2024 to 10-03-2025. Methods: A total of 80 diagnosed cases of hypothyroidism were enrolled. Among them, 50 (62.5%) were female and 30 (37.5%) were male. The Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Scale (HAM-A) were administered to assess depression and anxiety levels. Descriptive statistics were applied to evaluate prevalence, gender distribution, and symptom profiles. Results: Out of 80 patients, 74 (92.5%) exhibited varying degrees of depression on HDRS, including 46 females (62.1%) and 28 males (37.8%). Anxiety was identified in 68 patients (85.0%) on HAM-A, with 42 females (61.7%) and 26 males (38.2%). The most frequent depressive symptoms were depressed mood and gastrointestinal somatic complaints, while anxious mood and depressed mood were the predominant anxiety features. Conclusion: Hypothyroidism is strongly associated with psychiatric manifestations, particularly depression and anxiety. Routine psychological screening should be integrated into the management of hypothyroid patients to ensure timely intervention and improved outcomes.

FREQUENCY OF HYPERPARATHYROIDISM IN ADULT CHRONIC HEMODIALYSIS PATIENTS

A KHAN — 2025-07-18

Background: Secondary hyperparathyroidism (SHPT) is a frequent and significant complication in patients undergoing long-term hemodialysis. It arises due to chronic disturbances in mineral metabolism and is associated with adverse outcomes including bone disease and cardiovascular complications. Objective: This study aimed to determine the frequency of secondary hyperparathyroidism among adult patients receiving chronic hemodialysis. Study Design: This was a cross-sectional study. Setting: The study was conducted in the Nephrology Department of Rehman Medical Institute, Peshawar, Pakistan. Duration of Study: The data collection occurred over a defined study period (18-September-2024 to 18-March-2025). Methods: A total of 136 adult patients on maintenance hemodialysis for at least 12 months were enrolled. Secondary hyperparathyroidism was defined by parathyroid hormone (PTH) levels exceeding 70 pg/mL, in conjunction with hypocalcemia (serum calcium <8.5 mg/dL) and vitamin D deficiency (25(OH)-vitamin D <30 ng/mL). Relevant demographic and clinical information including comorbidities such as hypertension and diabetes was recorded. Data were analyzed using SPSS, with descriptive statistics used for frequency and mean calculations. Results: The mean age of participants was 51.71 ± 15.84 years. Of the total patients, 73 (53.7%) were male and 63 (46.3%) were female. Hypertension was observed in 56 patients (41.2%), and diabetes in 59 patients (43.4%). Secondary hyperparathyroidism was present in 85 patients, representing a frequency of 62.5%. Conclusion: A high prevalence of secondary hyperparathyroidism was observed among adult chronic hemodialysis patients. These findings emphasize the need for routine screening and timely intervention to manage mineral and bone disorders in this population.

COMPARISON OF WOUND DEHISCENCE IN CASES OF LAPAROTOMY CLOSED BY CONTINUOUS AND INTERRUPTED TECHNIQUE

ZU ISLAM — 2025-09-20

Background: Wound dehiscence is a serious postoperative complication following emergency laparotomy, associated with high morbidity and mortality. The choice of abdominal wall closure technique — continuous or interrupted — plays a key role in preventing this complication. Objective: To compare the frequency of wound dehiscence in cases of laparotomy closed by continuous versus interrupted techniques. Study Design: randomized controlled trial. Setting: The department of surgery, Saidu Sharif Medical College, Swat, Pakistan. Duration of Study: 10-01-2024 to 10-07-2024. Methods: A total of 184 patients undergoing emergency laparotomy were included and divided into two equal groups. Group A (n = 92) underwent closure with a continuous technique, while Group B (n = 92) underwent closure with an interrupted technique. Wound dehiscence was defined as the disruption of abdominal wall layers with serosanguinous discharge or evisceration within 15 postoperative days. Data were analyzed using SPSS, with a p-value <0.05 considered significant. Results: The mean age was 45.24 ± 16.02 years in Group A and 46.95 ± 15.43 years in Group B. In Group A, 57 (62.0%) were males and 35 (38.0%) females, while Group B included 54 (58.7%) males and 38 (41.3%) females. Wound dehiscence occurred significantly more frequently in the continuous group (16 patients, 17.4%) compared to the interrupted group (6 patients, 6.5%) (p < 0.05). Conclusion: The interrupted technique of laparotomy closure was associated with a significantly lower frequency of wound dehiscence compared to the continuous technique, suggesting it may be a safer option in emergency laparotomy cases.

CORRELATION OF TUMOR SIZE WITH VISUAL STATUS AMONGST PATIENTS WITH PITUITARY ADENOMA

SMSK QAISRANI — 2025-07-20

Background: Pituitary adenomas are benign neoplasms that can lead to substantial visual impairment due to their anatomical proximity to the optic chiasm. Visual dysfunction is often proportional to tumour size, with bitemporal hemianopia being the hallmark of chiasmal compression. Objective: To evaluate the correlation between tumour size and pre-operative visual field status in patients with pituitary adenoma. Study Design: Observational cross-sectional study. Settings: Conducted at the Punjab Institute of Neurosciences, Lahore, Pakistan. Duration of Study: 26 March 2025, 26 June 2025. Methods: A total of 60 patients aged 20–70 years with MRI-confirmed pituitary macroadenomas were enrolled. Tumor size (height) was measured in sagittal and coronal MRI scans (in mm ) using the method of Ikeda and Yoshimoto. Pre-operative visual function was evaluated using automated perimetry, with higher scores denoting greater visual impairment. Pearson correlation analysis was applied to determine the relationship between tumour size and visual field loss. Results: The mean tumour size in the coronal plane was 1.88 cm (SD = 0.686). A strong, statistically significant correlation was observed between sagittal and coronal measurements (r = 0.696, p < 0.001), confirming inter-plane consistency. The mean perimetry score was 2.00 (SD = 1.279). Bitemporal hemianopia was the most frequent visual defect (55.9%), followed by unilateral temporal with contralateral nasal hemianopia (17.6% and 14.7%, respectively), complete blindness (8.8%), and normal fields (2.9%). A significant positive correlation was found between larger coronal tumour size and worsening visual field scores (r = 0.682, p < 0.001; 95% CI: 0.482–0.821). Conclusion: Larger pituitary macroadenomas are strongly associated with greater visual field impairment pre-operatively. The predominance of bitemporal hemianopia supports classic optic chiasm compression, while the occurrence of atypical defects highlights anatomical variability. These findings reinforce the necessity for early neuroimaging and comprehensive visual assessment to facilitate prompt surgical intervention and preserve visual function.

FREQUENCY OF OBESITY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AT LADY READING HOSPITAL, PESHAWAR

H ANWAR — 2025-07-16

Background: Obesity is a significant public health concern and a well-recognized risk factor for the development and progression of type 2 diabetes mellitus (T2DM). Assessing the prevalence of obesity among T2DM patients is essential for effective disease management and prevention of complications. Objective: To determine the frequency of obesity in patients with T2DM presenting to Lady Reading Hospital, Peshawar. Study Design: Cross-sectional study. Setting: Department of Medicine, Lady Reading Hospital, Peshawar. Duration of Study: 04-October-2024 to 04-April-2025. Methods: A total of 119 patients with T2DM, aged 18–70 years, were enrolled using consecutive sampling. Obesity was defined as body mass index (BMI) ≥30 kg/m². Anthropometric measurements and relevant laboratory investigations were performed for all participants. Data were analyzed using descriptive statistics, with frequencies and percentages for categorical variables and mean ± standard deviation (SD) for continuous variables. Results: The mean age of participants was 50.25 ± 14.33 years. Of these, 57 (47.9%) were males and 62 (52.1%) were females. The prevalence of obesity was observed in 48 (40.3%) patients. The mean BMI was 28.58 ± 3.25. Hypertension was present in 69 (58.0%) patients, and 18 (15.1%) were smokers. Conclusion: Obesity was prevalent in 40.3% of T2DM patients in our study, highlighting the need for targeted interventions focusing on lifestyle modification and weight management to improve diabetes outcomes.

HEALTH-RELATED QUALITY OF LIFE IN DIABETIC FOOT ULCER PATIENTS: A CROSS-SECTIONAL ANALYSIS

FU RAHMAN — 2025-07-17

Background: Diabetic foot ulcers (DFUs) are one of the most debilitating complications of diabetes mellitus, often leading to infection, amputation, and reduced quality of life. Evaluating the health-related quality of life (HRQoL) in affected individuals is critical for optimizing patient care and targeted interventions. Objective: To determine the health-related quality of life (HRQoL) among patients with diabetic foot ulcers in the Department of Diabetes and Endocrinology at Lady Reading Hospital, Peshawar. Study Design: Cross-sectional study. Setting: Department of Diabetes and Endocrinology, Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: 20-10-2024 to 20-04-2025. Methods: A total of 283 patients diagnosed with diabetic foot ulcers were enrolled. HRQoL was assessed using the validated Short Form-36 (SF-36) questionnaire, which evaluates eight domains: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Additional clinical data regarding infection status, presence of neuropathy, and history of amputation were recorded. Data were analyzed using descriptive statistics; results were reported as mean ± standard deviation. Results: The mean age of participants was 53.75 ± 15.13 years, with females comprising 61.5% of the study population. Clinical complications included infections in 57.6%, neuropathy in 54.1%, and amputations in 20.8% of patients. HRQoL assessment revealed significant impairments in physical function (52.96 ± 13.65), role-physical (34.10 ± 3.83), and bodily pain (37.53 ± 10.76). Additionally, mental health (33.85 ± 9.40) and social functioning (32.66 ± 4.91) scores were markedly reduced. Conclusion: Patients with diabetic foot ulcers experience significant impairments in both physical and psychosocial aspects of health-related quality of life. These findings highlight the need for multidisciplinary care approaches focusing on both clinical management and psychological support to improve overall patient outcomes.

FREQUENCY OF HYPERTHYROIDISM IN PATIENTS PRESENTING WITH ATRIAL FIBRILLATION

I KHAN — 2025-07-20

Background: Hyperthyroidism is a recognized secondary cause of atrial fibrillation (AF) and contributes to increased morbidity. Early identification is essential for timely management. Objective: To determine the frequency of hyperthyroidism in patients presenting with atrial fibrillation and its associated factors. Study Design: Cross-sectional study. Setting: Department of Cardiology, Khyber Teaching Hospital, Peshawar, Pakistan. Duration of Study: From 07-February-2025 to 07-June-2025. Methods: A total of 260 patients with ECG-confirmed AF were enrolled. Diagnosis of hyperthyroidism was based on clinical features (weight loss, palpitations, tremors) and laboratory analysis (serum TSH <0.5 mIU/L with either free T3 >450 pg/dL or free T4 >1.8 ng/dL). Data on demographics, BMI, and comorbidities were collected. Statistical analysis was performed using SPSS; p-values <0.05 were considered significant. Results: The mean age was 51.05 ± 12.38 years, with 135 males (51.9%) and 125 females (48.1%). Hyperthyroidism was identified in 22 patients (8.5%). Female gender (p = 0.04) and presence of comorbidities (p = 0.003) were significantly associated with hyperthyroidism, while age and BMI showed no significant association. Conclusion: Hyperthyroidism was present in 8.5% of patients with AF, showing a significant association with female gender and comorbid conditions. Routine thyroid function screening is recommended in AF patients, particularly in females and those with comorbidities.

COMPARISON OF ANALGESIC EFFICACY OF TRANSVERSUS ABDOMINIS PLANE BLOCK VERSUS INFILTRATION OF LOCAL ANAESTHETIC INTO SURGICAL WOUND IN EMERGENCY LAPAROTOMIES

M NASEEM — 2025-07-14

Background: Effective postoperative pain management is critical in improving patient recovery and outcomes after emergency laparotomies. While both transversus abdominis plane (TAP) block and local anaesthetic infiltration (LAI) are used for analgesia, their comparative efficacy in this setting remains under-evaluated. Objective: To compare the analgesic efficacy of TAP block versus LAI into the surgical wound for postoperative pain management in emergency laparotomies. Study Design: Randomized controlled trial. Setting: The Department of Anaesthesia at Hayatabad Medical Complex, Peshawar, Pakistan. Duration of Study: 13-09-2024 to 13-03-2025. Methods: Sixty patients aged 20–60 years undergoing emergency laparotomies were randomly assigned into two equal groups (n = 30 each). Group T received the TAP block, while Group L received the LAI at wound closure. Postoperative pain was assessed at predefined intervals using the visual analogue scale (VAS). Data were analyzed using SPSS version [Insert Version]. Independent samples t-test was applied for continuous variables and chi-square test for categorical variables. A P value ≤ 0.05 was considered statistically significant. Results: The mean age was 37.73 ± 11.61 years in Group T and 39.77 ± 10.98 years in Group L. Group T patients reported a significantly lower mean VAS score (4.03 ± 1.61) compared to Group L (5.73 ± 2.08) (P = 0.001). Conclusion: TAP block was significantly more effective than LAI in reducing postoperative pain in emergency laparotomy patients, as demonstrated by notably lower VAS pain scores.

FREQUENCY OF THYROID DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS PRESENTING TO SAIDU GROUP OF TEACHING HOSPITAL, SWAT

Y ABBAS — 2025-07-15

Background: Thyroid dysfunction is frequently associated with type 2 diabetes mellitus (T2DM) due to shared pathophysiological mechanisms, including insulin resistance and autoimmune processes. Identifying its prevalence in diabetic populations is essential for early diagnosis and management. Objective: To determine the frequency of thyroid dysfunction in patients with T2DM presenting to Saidu Group of Teaching Hospital, Swat. Study Design: Cross-sectional study. Setting: Department of Medicine, Saidu Group of Teaching Hospital, Swat. Duration of Study: 11 July 2024 to 11 January 2025. Methods: A total of 185 patients aged 27–75 years with confirmed T2DM (defined as fasting plasma glucose ≥126 mg/dL, HbA1c ≥6.5%, or documented antidiabetic medication use for ≥3 years) were included. Thyroid dysfunction was defined as hypothyroidism (TSH <0.5 mIU/L in males, <0.4 mIU/L in females) or hyperthyroidism (TSH >4.15 mIU/L in males, >4.5 mIU/L in females). Data were analyzed using descriptive statistics, and stratification was performed by gender and family history. Results: The mean age of participants was 51.50 ± 14.31 years. The mean TSH level was 2.69 ± 1.47 mIU/L. Males constituted 103 (55.7%) and females 82 (44.3%) of the study population. Overall, thyroid dysfunction was observed in 46 (24.9%) patients, with higher frequency among females and those with a family history of thyroid disease. Conclusion: Thyroid dysfunction was present in approximately one-quarter of T2DM patients. Screening for thyroid disorders, particularly in females and individuals with a positive family history, may improve patient outcomes through earlier detection and management.

RELATION OF MAXILLARY SINUS FLOOR AND ROOT APICES OF MAXILLARY FIRST MOLAR IN SAGITTAL AND VERTICAL SKELETAL PATTERNS USING CONE BEAM COMPUTED TOMOGRAPHY SCANNING

M SHAH — 2025-07-17

Background: The anatomical proximity between the maxillary sinus floor (MSF) and the root apices of the maxillary first molar has important clinical implications for endodontic, orthodontic, and surgical procedures. Variations in skeletal patterns may influence this relationship, potentially affecting treatment outcomes. Objective: To determine the correlation between the distances from the root apices of the maxillary first molar to the maxillary sinus floor on cone beam computed tomography (CBCT) in different sagittal and vertical skeletal patterns. Study Design: Cross-sectional study. Setting: Department of Orthodontics, Fatima Memorial Hospital, Lahore, Pakistan. Duration of Study: From 16th November 2024 to 16th May 2025. Methods: A total of 41 patients aged 18–50 years of both genders were included. Subjects had fully developed and intact maxillary first molars with no history of orthodontic treatment, trauma, surgery, or craniofacial deformities. Patients with dental anomalies, syndromes, or root resorption were excluded. Participants were classified into sagittal (Class I, II, III) and vertical (hypo-, normo-, hyperdivergent) skeletal patterns. CBCT scans were analyzed using NNT software to measure the vertical distances from the mesiobuccal, distobuccal, and palatal root apices to the MSF. Data were analyzed using Spearman's correlation to assess associations with ANB and SN-MP angles. Results: The mean age of participants was 34.46 ± 9.74 years; 24 (58.5%) were male and 17 (41.5%) female. Most had Class I sagittal (48.8%) and normodivergent vertical (68.3%) skeletal patterns. The mesiobuccal root was closest to the MSF (3.33 ± 1.69 mm), followed by the distobuccal (3.49 ± 2.07 mm) and palatal roots (2.38 ± 1.97 mm). No statistically significant correlation was found between root–MSF distances and sagittal or vertical skeletal patterns (p > 0.05). Conclusion: There was no significant correlation between the root apices of the maxillary first molar and the maxillary sinus floor across sagittal or vertical skeletal patterns. The mesiobuccal root was the closest to the MSF, and younger patients tended to have shorter root–sinus distances.

FREQUENCY OF GASTROESOPHAGEAL REFLUX DISEASE AMONG PATIENTS PRESENTING WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

H ULLAH — 2025-07-14

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent and progressive respiratory condition frequently associated with comorbidities that complicate its management. Gastroesophageal reflux disease (GERD) is increasingly recognized as a common coexisting condition that can worsen respiratory symptoms and disease outcomes in COPD patients. Objective: To determine the frequency of gastroesophageal reflux disease (GERD) among patients presenting with chronic obstructive pulmonary disease (COPD). Study Design: Cross-sectional study. Setting: Conducted at a tertiary care hospital, the Department of Pulmonology, Mardan Medical Complex, Mardan, Pakistan. Duration of Study: 12 December 2024 to 12 May 2025. Methods: A total of 150 patients aged 30 to 70 years, of either gender, diagnosed with COPD, were enrolled in this study. Diagnosis of COPD was confirmed based on spirometric criteria (post-bronchodilator FEV₁/FVC ratio <0.70). GERD was diagnosed clinically based on the presence of retrosternal burning or acid regurgitation occurring at least twice weekly over the preceding month. Descriptive statistics were
used for analysis; results were expressed as mean ± standard deviation and percentages. Results: The mean age of participants was 54.21 ± 12.03
years. There were 94 males (62.7%) and 56 females (37.3%). COPD severity was classified as mild in 12 patients (8.0%), moderate in 66 (44.0%),
severe in 63 (42.0%), and very severe in 9 patients (6.0%). GERD was diagnosed in 78 patients, yielding a frequency of 52.0% among the COPD
cohort. The prevalence of GERD appeared to correlate with increasing COPD severity. Conclusion: GERD was identified in more than half of the COPD patients in this study, with a notable association between GERD frequency and COPD severity. These findings underscore the need for proactive GERD screening in the management of COPD to improve patient outcomes and quality of life.

COMPARATIVE EFFICACY OF SINGLE ORAL DOSE OF FLUCONAZOLE VS A SINGLE ORAL DOSE OF ITRACONAZOLE IN PATIENTS WITH PITYRIASIS VERSICOLOR

S ULLAH — 2025-07-14

Background: Pityriasis versicolor is a common superficial fungal infection caused by Malassezia species, presenting with hypo- or hyperpigmented scaly patches. Although systemic antifungal agents such as fluconazole and itraconazole are widely used, evidence regarding their comparative single-dose efficacy remains limited. Objective: To compare the efficacy of a single oral dose of fluconazole versus a single oral dose of itraconazole in the treatment of pityriasis versicolor. Study Design: Randomized controlled trial. Setting: Combined Military Hospital (CMH), Nowshera, Pakistan. Duration of Study: From 11 December 2024 to 11 May 2025. Methods: A total of 92 patients with clinically and microscopically confirmed pityriasis versicolor were enrolled through non-probability consecutive sampling and randomly allocated into two equal groups. Group A received a single oral dose of fluconazole 400 mg, while Group B received a single oral dose of itraconazole 400 mg. Diagnosis was confirmed using a Wood's lamp examination and a 10% KOH mount, which showed the characteristic "spaghetti and meatball" appearance. Treatment efficacy was defined as the absence of fungal elements on repeat KOH mount at 4 weeks post-treatment. Data were analyzed using SPSS version 25.0, with a chi-square test applied for comparison; p-value <0.05 was considered significant. Results: The mean age of participants was 33.11 ± 8.75 years in Group A and 32.00 ± 7.79 years in Group B, with no significant difference between groups. Fluconazole demonstrated significantly higher efficacy, with 82.6% (n = 38) of patients achieving clearance, compared to 60.9% (n = 28) in the itraconazole group (p = 0.02). Conclusion: A single oral dose of fluconazole was significantly more effective than a single oral dose of itraconazole in treating pityriasis versicolor. These findings support fluconazole as a superior first-line systemic treatment option for this condition.

PEDIATRIC AGE-ADJUSTED SHOCK INDEX IN SEPSIS: A PREDICTOR OF MORTALITY IN THE INTENSIVE CARE UNIT OF A TERTIARY CARE HOSPITAL

A REHMAN — 2025-07-14

Background: Sepsis remains a major cause of morbidity and mortality in pediatric intensive care units, especially in low and middle-income countries such as Pakistan. Early detection of hemodynamic compromise is crucial to improving clinical outcomes. The Shock Index Pediatric Age-Adjusted (SIPA) offers a non-invasive, rapid method for risk stratification and may serve as a valuable prognostic tool. Objective: To evaluate whether abnormal SIPA values at admission and 24 hours post-admission are associated with increased mortality and adverse outcomes in children with sepsis. Study Design: Prospective observational cohort study. Setting: Pediatric Intensive Care Unit (PICU), The Children’s Hospital, Lahore. Duration of Study: from March 2024 to March 2025. Methods: A total of 200 children aged 1 to 17 years with clinically diagnosed sepsis were enrolled using non-probability consecutive sampling. SIPA was calculated using heart rate and systolic blood pressure, categorized as normal or abnormal based on age-adjusted thresholds. Clinical outcomes assessed included mortality, mechanical ventilation (MV) requirement, inotropic support, and ICU length of stay. Statistical analysis was performed using SPSS version 26, including logistic regression to determine associations between SIPA and outcomes. Results: Abnormal SIPA was observed in 57% of patients at admission and in 38.5% at 24 hours. Persistently abnormal SIPA was significantly associated with higher mortality (21.6%) compared to patients with normalized SIPA (6.5%, P = 0.008). Abnormal SIPA at 24 hours was independently associated with increased mortality (OR = 3.92; 95% CI: 1.58–9.72; P = 0.003), need for mechanical ventilation (OR = 2.45; 95% CI: 1.38–4.35; P = 0.002), and prolonged ICU stay (mean increase: 2.4 days; P = 0.01). Conclusion: SIPA is a practical and effective bedside tool with strong prognostic value in pediatric sepsis. Monitoring SIPA at admission and 24 hours post-admission can aid early identification of high-risk patients, allowing timely interventions to improve outcomes, particularly in resource-limited healthcare settings.

ANTIBIOTIC SUSCEPTIBILITY PATTERN OF SALMONELLA TYPHI AND SALMONELLA PARATYPHI AT A TERTIARY CARE HOSPITAL IN PESHAWAR

. ZEESHAN — 2025-07-18

Background: Salmonella typhi and Salmonella paratyphi are leading causes of enteric fever in endemic regions. The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains has limited therapeutic options, making surveillance of local resistance patterns crucial for guiding empirical therapy. Objective: To determine the antibiotic susceptibility pattern of Salmonella typhi and Salmonella paratyphi at a tertiary care hospital in Peshawar. Study Design: Cross-sectional study. Setting: Department of Microbiology, Rehman Medical Institute, Peshawar. Duration of Study: 24-November-2024 to 24-May 2025. Methods: A total of 139 patients with culture-proven Salmonella typhi or Salmonella paratyphi infection were included. Antibiotic susceptibility was assessed using the standard Kirby-Bauer disk diffusion method. MDR and XDR strains were identified according to established definitions. Potential confounders stratified frequencies, and post-stratification comparisons were performed using the Chi-square test. Results: The mean age of patients was 35.27 ± 9.90 years, with 98 (70.5%) males and 41 (29.5%) females. The mean BMI was 17.80 ± 1.89 kg/m², and the mean duration of fever was 5.16 ± 1.92 days. Of the isolates, 97 (69.8%) were S. typhi and 42 (30.2%) were S. paratyphi. MDR strains were identified in 25 (18.0%) cases and XDR strains in 61 (43.9%). The highest sensitivity was observed with meropenem (80.4%) and azithromycin (71.1%). Conclusion: Antibiotic resistance among Salmonella isolates was highly prevalent, with MDR and XDR strains observed in 18% and 43.9% of cases, respectively. Meropenem and azithromycin remain the most effective treatment options in this setting, emphasising the urgent need for antimicrobial stewardship and continuous resistance surveillance.

FREQUENCY OF HYPOCALCEMIC TETANY IN PATIENT UNDERGOING TOTAL AND NEAR TOTAL THYROIDECTOMY

A AHMAD — 2025-07-21

Background: Hypocalcemic tetany is one of the most common and clinically significant complications following thyroid surgery. Its occurrence is primarily linked to hypoparathyroidism caused by inadvertent parathyroid injury or devascularization during surgery. Identifying its frequency and associated risk factors is crucial to improving patient safety and outcomes. Objective: To investigate the frequency of hypocalcemic tetany in patients undergoing total and near-total thyroidectomy. Study Design: Descriptive Case Series. Setting: The study was conducted at the Department of Otolaryngology, Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: 1^st-December-2024 to 1st-June-2025. Methods: A total of 289 patients aged 20–60 years undergoing total or near-total thyroidectomy for goiter or Graves' disease were included. Hypocalcemic tetany was defined as the occurrence of carpopedal spasm with serum calcium <8.5 mg/dL within 72 hours postoperatively. Data were analyzed using descriptive statistics. Chi-square test was applied to determine associations between variables, with p ≤ 0.05 considered significant. Results: The mean age of participants was 36.22 ± 10.83 years. Of the total, 168 (58.1%) were females and 121 (41.9%) were males. Hypocalcemic tetany was observed in 15.6% of patients, with significantly higher incidence among females (73.3% vs. 26.7% males, p = 0.02) and in those with Graves' disease compared to goiter (73.3% vs. 26.7%, p = 0.01). Postoperative calcium supplementation was associated with a reduced risk of tetany. Conclusion: Hypocalcemic tetany was identified in 15.6% of patients following total and near-total thyroidectomy. Female gender and Graves' disease were significant predictors. Prophylactic calcium supplementation may play a protective role in reducing postoperative complications.

FREQUENCY OF ENLARGEMENT OF EXTRADURAL HEMATOMA IN REPEAT CT SCAN IN CONSERVATIVELY MANAGED TRAUMA PATIENTS

M SAQIB — 2025-07-17

Background: Extradural hematoma (EDH) is a potentially life-threatening complication of head trauma. While surgical intervention is indicated for large or rapidly expanding hematomas, many cases are initially managed conservatively. Repeat CT imaging is crucial for monitoring progression; however, the frequency of enlargement in this setting is variably reported. Objective: To determine the frequency of enlargement of extradural hematoma on repeat CT scans in patients with conservatively managed head trauma. Study Design: Descriptive cross-sectional study. Setting: Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: 25-November-2024 to 25-May-2025. Methods: A total of 126 patients aged 5–60 years presenting within 24 hours of head trauma were enrolled. The inclusion criteria were a Glasgow Coma Scale (GCS) score greater than 12 and the absence of concurrent surgical pathologies. All patients were managed conservatively and underwent repeat CT scans 48 hours later. EDH enlargement was defined as a biconvex hyperdensity with thickness >10 mm, midline shift >6 mm, or volume >30 ml. Data were analyzed using SPSS 26. Results: The mean age was 19.60 ± 13.74 years, with a male predominance (77.0%). Road traffic accidents were the most common cause of injury (53.2%), followed by falls from height (34.1%) and assault (12.7%). Enlargement of EDH was observed in 25 patients, yielding a frequency of 19.8%. Conclusion: Nearly one-fifth of conservatively managed EDH cases showed enlargement on repeat CT scans. Routine follow-up imaging at 48 hours is recommended, especially in high-risk patients, to ensure timely surgical intervention and improve outcomes.

HYPONATREMIA FOLLOWING ANEURYSMAL SUBARACHNOID HEMMORHAGE

ZU REHMAN — 2025-08-01

Background: Hyponatremia is a frequent electrolyte disturbance in patients with aneurysmal subarachnoid hemorrhage (aSAH), often contributing to worsened neurological outcomes. Understanding its prevalence and clinical implications is crucial for timely intervention. Objective: To assess the frequency and severity of hyponatremia in patients with aneurysmal subarachnoid hemorrhage and evaluate its association with clinical outcomes. Study Design: cross-sectional study. Setting: The study was conducted in the neurosurgery and neurology units of a tertiary care hospital. Duration of Study: November 2024 to May 2025. Methods: Fifty-five patients aged above 18 years with radiologically confirmed aSAH (via CT angiography or digital subtraction angiography) were enrolled. Daily serum sodium levels were monitored and categorized as mild (<135 mmol/L), moderate (<130 mmol/L), or severe (<125 mmol/L) hyponatremia. Clinical outcomes were assessed using the Glasgow Outcome Scale (GOS) at the time of hospital discharge. Statistical analysis was performed using SPSS software, with significance defined at p < 0.05. Results: The mean patient age was 55.2 ± 3.8 years, with females comprising 60% of the study population. The most common aneurysm location was the anterior communicating artery (27.3%). Hyponatremia was observed in all patients: mild in 61.8%, moderate in 29.1%, and severe in 9.1% of cases. Severe hyponatremia showed a significant association with poorer clinical outcomes (p = 0.01). Conclusion: Hyponatremia is highly prevalent among patients with aneurysmal subarachnoid hemorrhage. Severe hyponatremia is notably associated with unfavorable neurological outcomes, underlining the importance of early detection and management in aSAH patients.

FUNCTIONAL OUTCOMES OF LOCKING PLATE FIXATION IN THE MANAGEMENT OF DISPLACED OLECRANON FRACTURES AMONG ADULT PATIENTS PRESENTING TO TERTIARY CARE HOSPITAL

MA KHAN — 2025-07-14

Background: Displaced olecranon fractures are common upper limb injuries in adults and often require surgical intervention to restore elbow function. Locking plate fixation has gained increasing popularity due to its biomechanical stability and ability to allow early mobilization. Objective: To evaluate the functional outcomes of locking plate fixation in the management of displaced olecranon fractures among adult patients. Study Design: Descriptive study. Setting: Department of Orthopedic Surgery, MTI-Khyber Teaching Hospital, Peshawar, Pakistan. Duration of Study: 18-October-2024 to 18-May-2025. Methods: A total of 114 adult patients aged 18–65 years with displaced olecranon fractures were included in this study. All patients underwent open reduction and internal fixation with an olecranon locking plate through a posterior midline approach under general anesthesia, with intraoperative imaging utilized when required. Functional outcomes were assessed at two months postoperatively using the Broberg and Morrey rating system. Data were analyzed using SPSS version 25. Results: The mean age of patients was 45.44 ± 14.42 years, with 59 (51.8%) males and 55 (48.2%) females. Functional outcomes were excellent in 79.8% of cases, good in 14.0%, and fair in 6.1%, with no poor outcomes reported. Conclusion: Locking plate fixation of displaced olecranon fractures demonstrated excellent to good functional outcomes in the majority of patients, highlighting its effectiveness in restoring elbow function with minimal complications.

COMPARISON OF THE EFFICACY OF INTRALESIONAL VITAMIN D3 AND INTRALESIONAL 5 FLUOROURACIL IN TREATMENT OF CUTANEOUS WARTS

H ULLAH — 2025-07-16

Background: Cutaneous warts are common benign skin lesions caused by human papillomavirus (HPV) and can be resistant to conventional therapies. Intralesional therapies such as vitamin D3 and 5-fluorouracil (5-FU) have emerged as promising treatment options, yet their comparative efficacy remains under-investigated. Objective: To compare the efficacy of intralesional vitamin D3 and intralesional 5-FU in the treatment of cutaneous warts. Study Design: Randomized controlled trial. Setting: Department of Dermatology, Khyber Teaching Hospital, Peshawar, Pakistan. Duration of Study: 29-September-2024 to 29-March-2025. Methods: A total of 192 patients with clinically diagnosed cutaneous warts were included and randomly assigned into two equal groups. Group A received intralesional vitamin D3 (0.2–0.5 mL of 15 mg/mL) combined with lidocaine-adrenaline, while Group B received intralesional 5-FU (10 units of 250 mg/5 mL) in the same anesthetic solution. Treatment efficacy was defined as >50% reduction in lesion size and number assessed visually. Data were analyzed using appropriate statistical tests, with a p-value <0.05 considered significant. Results: The mean age of participants in Group A was 33.04 ± 11.89 years, while in Group B it was 33.30 ± 11.31 years. The efficacy rate was significantly higher in the 5-FU group (82%) compared to the vitamin D3 group (64%) (p < 0.05). Conclusion: Intralesional 5-FU demonstrated superior efficacy compared to vitamin D3 in the treatment of cutaneous warts, suggesting that 5-FU may be preferred in clinical practice.

FREQUENCY OF POSTOPERATIVE FECAL INCONTINENCE IN PATIENTS UNDERGOING OPEN ANAL INTERNAL SPHINCTEROTOMY FOR CHRONIC ANAL FISSURE

M ABBAS — 2025-07-19

Background: Chronic anal fissure is a common proctologic condition characterized by pain and bleeding during defecation. Open anal internal sphincterotomy is considered the gold standard surgical treatment, though postoperative fecal incontinence remains a concerning complication that can affect quality of life. Objective: To determine the frequency of postoperative fecal incontinence in patients undergoing open anal internal sphincterotomy for chronic anal fissure. Study Design: Descriptive study. Setting: The Department of General Surgery at Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: 01-12-2024 to 01-05-2025. Methods: A total of 101 patients with chronic anal fissure were enrolled. Chronic fissure was defined as painful defecation with bleeding per rectum persisting for more than six weeks, with clinical findings of an anal mucosal tear or sentinel pile. All patients underwent open anal internal sphincterotomy under general anesthesia. Postoperative fecal incontinence was defined as uncontrolled passage of feces for ≥15 days after surgery. Data were analyzed using descriptive statistics. Results: The mean age of participants was 40.54 ± 14.85 years. There were 63 males (62.4%) and 38 females (37.6%). Postoperative fecal incontinence occurred in 15 patients, representing a frequency of 14.9%. Conclusion: Open anal internal sphincterotomy is an effective treatment for chronic anal fissure; however, postoperative fecal incontinence occurred in 14.9% of cases. Careful patient selection, preoperative counseling, and long-term follow-up are recommended to minimize and monitor this complication.

FETOMATERNAL OUTCOME IN OBESE PREGNANT WOMEN WITH PREGNANCY INDUCED HYPERTENSION VISITING LIAQAT MEMORIAL HOSPITAL, KOHAT

M SALEEM — 2025-07-15

Background: Obesity and pregnancy-induced hypertension (PIH) are independently associated with adverse fetomaternal outcomes. When occurring together, they may significantly increase maternal and perinatal morbidity and mortality. Timely identification of complications can guide preventive strategies. Objective: To evaluate the fetomaternal outcomes in obese pregnant women with pregnancy-induced hypertension presenting at Liaqat Memorial Hospital, Kohat, Pakistan. Study Design: Descriptive observational study. Setting: Department of Obstetrics and Gynecology, Liaqat Memorial Hospital, Kohat. Duration of Study: 23-08-2024 to 23-02-2025. Methods: A total of 127 obese pregnant women (BMI ≥30 kg/m²) aged 15–45 years with singleton pregnancies and diagnosed with PIH were enrolled. Fetomaternal outcomes assessed over a 42-day follow-up included eclampsia, HELLP syndrome, placental abruption, fetal growth restriction, preterm birth, fetal hypoxia, perinatal death, and maternal mortality. Data were analyzed using descriptive statistics. Results: The mean age of participants was 28.52 ± 8.89 years. Maternal complications observed were eclampsia in 14.2% of cases, HELLP syndrome in 3.9%, and placental abruption in 7.1%. Fetal complications included fetal growth restriction in 16.5%, preterm birth in 15.7%, fetal hypoxia in 6.3%, and perinatal death in 3.9% of cases. Maternal mortality was recorded in 4.7% of the participants. Conclusion: Among fetal outcomes, fetal growth restriction and preterm birth were the most common complications. In maternal outcomes, eclampsia and placental abruption were the most frequently observed. These findings highlight the need for vigilant monitoring and multidisciplinary management of obese pregnant women with PIH to reduce adverse outcomes.

BACTERIOLOGICAL PROFILE OF NEONATAL SEPTICEMIA AND ANTIBIOTIC SUSCEPTIBILITY PATTERN OF THE ISOLATES IN TERTIARY CARE HOSPITAL

A SHAH — 2025-07-18

Background: Neonatal septicemia is a major cause of morbidity and mortality worldwide, particularly in developing countries. The identification of causative organisms and their antibiotic susceptibility patterns is essential for guiding effective empirical therapy and reducing adverse outcomes. Objective: To determine the bacteriological profile of neonatal septicemia and evaluate the antibiotic susceptibility patterns of the isolates in a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatrics at Combined Military Hospital, Abbottabad, Pakistan. Duration of Study: 12-January-2025 to 12-May-2025. Methods: A total of 176 neonates aged 1–20 days presenting with clinical signs of septicemia and positive blood cultures were enrolled. Standard microbiological techniques were used to isolate and identify causative organisms, including Pseudomonas, Staphylococcus epidermidis, Candida, Staphylococcus aureus, Acinetobacter, and Klebsiella. Antibiotic susceptibility testing was performed for meropenem, amikacin, tigecycline, vancomycin, ciprofloxacin, linezolid, colistin, and cefepime using standard protocols. Data analysis was carried out using SPSS version 24. Results: The mean age of the neonates was 10.37 ± 5.64 days, with a mean birth weight of 3.44 ± 0.44 kg. Gram-negative organisms predominated, with Klebsiella (30.1%) and Acinetobacter (25.6%) being the most frequently isolated organisms. High resistance rates were observed against cefepime (73.9%) and ciprofloxacin (56.2%). The highest susceptibility rates were noted for vancomycin (90.9%), linezolid (88.1%), and colistin (81.2%). Conclusion: Klebsiella and Acinetobacter were the leading causes of neonatal septicemia in this study. Vancomycin, linezolid, and colistin showed the greatest sensitivity and may be considered effective options for empirical therapy in neonatal septicemia.

FREQUENCY OF CONGENITAL HYPOTHYROIDISM IN PRETERM AND LOW BIRTH WEIGHT NEONATES IN A TERTIARY CARE HOSPITAL

J ZAHID — 2025-07-18

Background: Congenital hypothyroidism (CH) is a preventable cause of neurodevelopmental impairment. Preterm and low birth weight neonates are at heightened risk and may require repeat thyroid-stimulating hormone (TSH) screening to avoid missed or delayed diagnoses. Objective: To determine the frequency of CH in preterm and low birth weight neonates admitted to a tertiary care hospital and to explore its association with key perinatal variables. Study Design: Descriptive cross-sectional study. Settings: Department of Pediatrics, Chaudhry Muhammad Akram Teaching and Research Hospital, Lahore, Pakistan. Duration of Study: 3 December 2024 to 3 June 2025. Methods: A total of 165 neonates who were preterm (<37 weeks' gestation) or low birth weight (<2500 g) were enrolled through non-probability consecutive sampling. Dried blood spot specimens were analyzed for TSH using an immunoradiometric assay. CH was defined as TSH ≥20 mIU/L. Associations between CH status and age at testing, sex, gestational age, and mode of delivery were evaluated with a two-sided α of 0.05. Results: The mean gestational age was 33.29 ± 1.78 weeks, and the mean birth weight was 1841.56 ± 310.97 g. CH was detected in 10.3% (n=17/165) of neonates. There was no statistically significant association between CH and age at testing (p=0.704), sex (p=0.778), gestational age (p=0.923), or mode of delivery (p=0.189). Conclusion: A notably high frequency of CH was observed among preterm and low birth weight neonates in this tertiary care setting. These data support routine and repeat TSH screening in this high-risk population to enable timely diagnosis and initiation of therapy.

VALIDATION OF AGE, BLOOD PRESSURE, CLINICAL FEATURES, DURATION, AND DIABETES SCORE AS IDENTIFYING INDIVIDUALS AT HIGH EARLY RISK OF STROKE AFTER A TRANSIENT ISCHEMIC ATTACK AT JINNAH POSTGRADUATE MEDICAL CENTRE, KARACHI

A ABRAR — 2025-07-20

Background: Transient ischemic attack (TIA) is a major predictor of subsequent stroke, with the highest risk occurring in the early post-attack period. The ABCD² score is a widely used clinical tool for stratifying this risk; however, local validation is required to determine its predictive accuracy in South Asian populations. Objective: To validate the ABCD² score in identifying individuals at high early risk of stroke following a transient ischemic attack at Jinnah Postgraduate Medical Centre (JPMC), Karachi. Study Design: Cross-sectional study. Setting: Ward 28, Department of Neurology, Jinnah Postgraduate Medical Centre (JPMC), Karachi. Duration of Study: 20 January 2025 to 20 June 2025. Methods: Following ethical approval, 93 patients aged 18–70 years of both genders presenting with TIA were enrolled using non-probability consecutive sampling. Patients with a history of stroke, head trauma, atrial fibrillation, or intracerebral hemorrhage were excluded. ABCD² scores were calculated at presentation, and patients were followed for the occurrence of stroke. Data were analyzed using descriptive statistics, and associations between clinical variables and stroke outcomes were assessed using chi-square tests and t-tests, with p < 0.05 considered statistically significant. Results: The mean ABCD² score was 2.9 ± 2.1. Stroke occurred in 50 patients (54%). Age was significantly associated with stroke (p=0.018), with higher occurrence among patients >30 years (37 vs. 13 cases). Hypertension (p=0.004), diabetes mellitus (p<0.0001), myocardial infarction (p<0.0001), angioplasty (p<0.0001), CABG (p<0.0001), and angina (p=0.036) were significantly linked to stroke occurrence. Gender (p = 0.229), hyperlipidemia (p = 0.099), and smoking (p = 0.673) showed no significant association. Conclusion: The ABCD² score demonstrated predictive utility for early stroke risk among TIA patients in our cohort. However, significant associations with comorbidities such as hypertension, diabetes, and ischemic heart disease suggest that region-specific, comprehensive risk assessment models may provide superior predictive value for South Asian populations.

COMPARATIVE STUDY OF LAPAROSCOPIC VERSUS OPEN SURGICAL TREATMENT IN THE MANAGEMENT OF HEPATIC HYDATID CYST

S KHAN — 2025-07-14

Hepatic hydatid disease, caused by Echinococcus granulosus, remains a significant surgical concern in endemic regions. While open surgery has traditionally been the standard approach, laparoscopic techniques are increasingly being utilized with potential advantages in recovery and complication rates. Objective: To compare laparoscopic versus open surgical treatment in the management of hepatic hydatid cysts with respect to postoperative hospital stay and wound infection rates. Study Design: Comparative cross-sectional study. Setting: Conducted at a tertiary care hospital, the General Surgery Department of Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: 11-Novemeber-2023 to 11-May-2024. Methods: A total of 94 patients aged 30 to 80 years with ultrasound-confirmed hepatic hydatid cysts were included and equally divided into two groups: laparoscopic surgery (Group A) and open surgery (Group B). Postoperative hospital stay duration and wound infection rates were recorded. Data were analyzed using appropriate statistical methods, and a p-value of <0.05 was considered significant. Results: The mean age was 49.49 ± 13.65 years in Group A and 47.96 ± 11.89 years in Group B. The mean postoperative hospital stay was significantly shorter in the laparoscopic group (4.57 ± 1.03 days) compared to the open surgery group (6.02 ± 1.42 days; p = 0.0001). Wound infection occurred in 2.1% of laparoscopic cases versus 14.9% in open surgery cases. Conclusion: Laparoscopic management of hepatic hydatid cyst is associated with a significantly shorter hospital stay and lower wound infection rate compared to open surgery, making it a more effective and less morbid treatment option

FREQUENCY OF SURGICAL SITE INFECTIONS IN PATIENTS UNDERGOING OPEN CHOLECYSTECTOMY

H ALI — 2025-07-19

Background: Surgical site infection (SSI) is a common postoperative complication of open cholecystectomy, contributing to increased morbidity, prolonged hospital stays, and higher healthcare costs. Identifying patient-related risk factors is crucial for improving surgical outcomes. Objective: To determine the frequency of SSI in patients undergoing open cholecystectomy and evaluate associated risk factors. Study Design: Descriptive study. Setting: Department of General Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan. Duration of Study: 19-03-2025 to 19-06-2025. Methods: A total of 138 patients undergoing elective open cholecystectomy for symptomatic gallstones were included through non-probability consecutive sampling. All surgeries were performed using a standardized Kocher's incision with prophylactic antibiotics administered. Patients were monitored for 30 days postoperatively for SSI, defined by redness, warmth, localized swelling, pain, tenderness, or purulent discharge at the incision site. Data were analyzed using SPSS 27. Results: The mean age was 46.57 ± 9.60 years. Females constituted the majority (60.9%). The overall frequency of SSI was 14.5%. SSI occurrence was significantly higher in patients over 50 years of age (p = 0.006), in males (p = 0.0001), and in patients with a body weight greater than 75 kg (p = 0.005). Conclusion: The frequency of SSI after open cholecystectomy was 14.5%. Advanced age, male gender, and higher body weight were identified as significant risk factors for the condition. Preventive strategies targeting high-risk groups may reduce postoperative infections.

CONGENITAL ABNORMALITIES IN NEWBORNS OF CONSANGUINEOUS AND NON-CONSANGUINEOUS PARENTS

K SABAHAT — 2025-07-14

Background: Congenital abnormalities contribute significantly to neonatal morbidity and mortality worldwide. Consanguinity is recognized as a potential risk factor for various structural and genetic malformations, yet its impact on the prevalence of specific anomalies in local populations remains underreported. Objective: To determine the frequency of congenital abnormalities in newborns of consanguineous versus non-consanguineous parents. Study Design: Cross-sectional study. Setting: Department of Obstetrics and Gynecology, Saidu Medical College, Swat, Pakistan. Duration of Study: November 1, 2024, to May 1, 2025. Methods: A total of 207 women with fetuses diagnosed with congenital malformations were enrolled. Diagnoses included clubfoot, congenital heart disease, cleft palate, polycystic kidney disease, and anencephaly, confirmed through physical examination and relevant diagnostic tests. Frequencies of anomalies were compared between consanguineous and non-consanguineous groups using the chi-square test, with p-values <0.05 considered statistically significant. Results: The mean maternal age was 27.52 ± 7.80 years. Congenital heart disease was significantly more common among consanguineous cases (17.4%) than non-consanguineous cases (3.6%) (p = 0.001). Similarly, cleft palate occurred in 15.9% vs. 2.9%, polycystic kidney disease in 7.2% vs. 1.4%, and anencephaly in 5.8% vs. 0.7%, respectively. Conclusion: Congenital abnormalities were significantly more frequent among newborns of consanguineous parents compared to those of non-consanguineous parents. These findings highlight the importance of genetic counseling and public health interventions in populations with high rates of consanguineous marriages.

COMPARATIVE EFFICACY OF TOPICAL CLOBETASOL PROPIONATE 0.05% OINTMENT AND TOPICAL TACROLIMUS 0.1% OINTMENT IN THE TREATMENT OF ALOPECIA AREATA

M ISHAQ — 2025-07-17

Background: Alopecia areata (AA) is a chronic autoimmune disorder characterized by nonscarring hair loss. Various topical therapies are used, yet their relative efficacy remains debated. Objective: To compare the efficacy of topical clobetasol propionate 0.05% and topical tacrolimus 0.1% ointment in the treatment of alopecia areata. Study Design: Randomized controlled trial. Setting: Dermatology Department, Combined Military Hospital (CMH), Nowshera, Pakistan. Duration of Study: 11-October-2024 to 11-April-2025. Methods: A total of 62 patients with ≤3 Alopecia areata patches (≤3 cm diameter) and no systemic autoimmune disorders were recruited. Participants were randomized into two equal groups (n = 31 each) using a blocked randomization method. Group A applied clobetasol propionate 0.05% ointment twice daily, while Group B applied tacrolimus 0.1% ointment for three months. Efficacy was assessed using the Severity of Alopecia Tool (SALT) score, with treatment success defined as a SALT score ≤4. Statistical significance was assessed using the chi-square test, with p < 0.05 considered statistically significant. Results: The mean age in Group A was 33.06 ± 11.67 years, while in Group B it was 30.45 ± 12.33 years. Treatment success was achieved in 23 patients (74.2%) in the clobetasol group, compared to 14 patients (45.2%) in the tacrolimus group, showing a statistically significant difference (p = 0.02). Conclusion: Topical clobetasol propionate 0.05% demonstrated superior efficacy compared to topical tacrolimus 0.1% in the treatment of alopecia areata, highlighting its role as a preferred first-line topical therapy.

FREQUENCY OF CARDIOGENIC SHOCK IN ADULT PATIENTS WITH NON-ST-ELEVATION MYOCARDIAL INFARCTION

ROOHULAMIN . — 2025-07-18

Background: Cardiogenic shock (CS) is a serious and potentially fatal complication of acute coronary syndromes, including non-ST-elevation myocardial infarction (NSTEMI). Identifying its frequency and associated risk factors is essential for prompt risk stratification and management. Objective: To determine the frequency of cardiogenic shock in adult patients presenting with NSTEMI. Study Design: Cross-sectional. Setting: Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: From November 8, 2024, to May 8, 2025. Methods: A total of 146 patients aged 30 to 70 years diagnosed with NSTEMI were enrolled consecutively. Cardiogenic shock was defined as a systolic blood pressure <90 mmHg for ≥30 minutes, a cardiac index <1.8 L/min/m², or pulmonary capillary wedge pressure >18 mmHg. Clinical variables, including diabetes, hypertension, and smoking status, were recorded. Data were analyzed using appropriate statistical methods to determine associations (p<0.05 considered significant). Results: The mean age of the study population was 57.91 ± 10.38 years. Among the patients, 92 (63.0%) were male and 54 (37.0%) were female. Cardiogenic shock was diagnosed in 9 patients (6.2%). A statistically significant association was found between cardiogenic shock and diabetes (p=0.04), hypertension (p=0.009), and smoking (p=0.0001). Conclusion: Cardiogenic shock occurred in 6.2% of patients with NSTEMI in this study. Diabetes, hypertension, and smoking were significantly associated with the development of cardiogenic shock, underscoring the need for careful monitoring and early intervention in high-risk individuals.

ASSOCIATION OF GENDER WITH IN-HOSPITAL OUTCOMES OF ST-ELEVATION MYOCARDIAL INFARCTION

N SULTAN — 2025-07-16

Background: ST-elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality worldwide. Gender-based differences in in-hospital outcomes following STEMI have been reported, but data from local populations are limited. Objective: To determine the frequency of in-hospital outcomes of STEMI and compare them between male and female patients. Study Design: Descriptive study. Setting: Department of Cardiology, Khyber Teaching Hospital, Peshawar, Pakistan. Duration of Study: 06-February-2025 to 06-June-2025. Methods: A total of 251 patients (aged 30–75 years) of either gender, diagnosed with STEMI confirmed by ECG and elevated cardiac troponin levels, were included in this study. In-hospital outcomes assessed were tricuspid regurgitation, mitral regurgitation, arrhythmia, and heart failure. Data were analysed using SPSS version 21; the chi-square test was applied to compare categorical variables, with p < 0.05 considered statistically significant. Results: The mean age of patients was 58.00 ± 13.23 years, with 133 (53.0%) males and 118 (47.0%) females. Overall in-hospital outcomes included tricuspid regurgitation (31.9%), mitral regurgitation (20.3%), arrhythmia (19.1%), and heart failure (12.0%). Heart failure was significantly more frequent in females compared to males (18.6% vs. 6.0%; p = 0.002), while mitral regurgitation was also more common among females (26.3% vs. 15.0%; p = 0.02). Conclusion: Tricuspid regurgitation was the most frequent in-hospital outcome of STEMI, followed by mitral regurgitation and arrhythmia. Heart failure and mitral regurgitation occurred significantly more often in females, highlighting the need for gender-specific management strategies in STEMI patients.

FREQUENCY OF VITAMIN D DEFICIENCY IN PATIENTS WITH LOW ENERGY HIP FRACTURE PRESENTING TO ORTHOPEDIC DEPARTMENT OF LADY READING HOSPITAL PESHAWAR

SU REHMAN — 2025-07-14

Background: Vitamin D plays a critical role in bone health, and its deficiency has been associated with increased risk of fragility fractures. Low-energy hip fractures are common in the elderly and often indicate underlying metabolic bone disease. Understanding the prevalence of vitamin D deficiency in this population can guide preventive and therapeutic strategies. Objective: To determine the frequency of vitamin D deficiency in patients with low-energy hip fractures presenting to the Orthopedic Department of Lady Reading Hospital, Peshawar. Study Design: Descriptive cross-sectional study. Setting: Orthopedic Department, Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: Six months (27-May-2024 to 27-November-2024). Methods: A total of 95 patients aged above 50 years, diagnosed with low-energy hip fractures, were included in the study. Patients with pathological fractures, high-energy trauma, or prior vitamin D supplementation were excluded. A 5-cc venous blood sample was collected from each participant to measure serum vitamin D levels using standard laboratory methods. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D level <20 ng/mL. Data were analyzed using SPSS version 25. Descriptive statistics were used to calculate means and standard deviations for continuous variables, and frequencies and percentages for categorical variables. Results: The mean age of participants was 68.11 ± 10.38 years, with females comprising 61.1% of the study population. The mean serum vitamin D level was 19.35 ± 3.49 ng/mL. Vitamin D deficiency was observed in 74.7% of patients with low-energy hip fractures. Conclusion: This study demonstrated a high prevalence of vitamin D deficiency among patients with low-energy hip fractures. Routine screening and appropriate supplementation strategies should be considered to reduce the risk of fractures and improve bone health in this high-risk population.

FREQUENCY OF APPENDIX PERFORATION IN PATIENTS PRESENTING WITH ACUTE APPENDICITIS

U MIR — 2025-07-16

Background: Acute appendicitis is one of the most common surgical emergencies worldwide, with appendix perforation being a major complication that increases morbidity and mortality. Identifying the frequency and risk factors associated with perforation is essential for early intervention and improved patient outcomes. Objective: To determine the frequency of appendix perforation in patients presenting with acute appendicitis. Study Design: Cross-sectional study. Setting: The Department of Surgery, Saidu Group of Teaching Hospital in Swat, Pakistan. Duration of Study: 09-March-2024 to 09-September-2024. Methods: A total of 169 patients aged 18–60 years with ultrasound-confirmed acute appendicitis were included. Diagnosis was based on ultrasonographic findings, including wall thickening (>3 mm), hyperechoic appendicolith, echogenic periappendiceal fat, and appendix diameter >6 mm. Appendix perforation was diagnosed using predefined ultrasonographic criteria, including appendix diameter >6 mm, wall thickness ≥3 mm, and evidence of peritoneal spillage. Clinical data, including age, hypertension status, and diabetes status, were also recorded. Statistical analysis was performed to assess the frequency and associated risk factors. Results: The mean age of patients was 33.20 ± 11.72 years. Among them, 99 (58.6%) were males and 70 (41.4%) were females. The frequency of appendix perforation was 16.6%. Higher age, hypertension, and diabetes showed a significant association with appendix perforation. Conclusion: Appendix perforation occurred in 16.6% of patients with acute appendicitis in our study, with older age and comorbidities such as hypertension and diabetes emerging as key associated factors. Early diagnosis and timely surgical intervention are critical to reducing complications.

EARLY POSTOPERATIVE COMPLICATIONS OF ENDOSCOPIC ENDONASAL TRANS-SPHENOIDAL SURGERY IN PATIENTS WITH PITUITARY ADENOMA

M ANEEQ — 2025-07-19

Background: Endoscopic endonasal trans-sphenoidal surgery is widely used for the management of pituitary adenomas. While it offers several advantages over traditional approaches, early postoperative complications can affect patient outcomes and recovery. Objective: To determine the frequency of early postoperative complications following endoscopic endonasal transsphenoidal surgery in patients diagnosed with pituitary adenoma. Study Design: A descriptive study. Setting: The study was carried out in a tertiary care center equipped with endoscopic neurosurgical facilities (the Neurosurgery Department of Irfan General Hospital, Peshawar). Duration of Study: Postoperative outcomes were monitored for 30 days following surgery. Methods: Ninety-seven patients with pituitary adenomas confirmed on MRI underwent endoscopic endonasal transsphenoidal surgery. Early postoperative complications assessed within the 30-day postoperative period included hyponatremia (serum sodium <135 mEq/L), diabetes insipidus (characterized by polyuria with low urine specific gravity), hypopituitarism (specifically, growth hormone deficiency), and cerebrospinal fluid (CSF) leak, confirmed via beta-2 transferrin testing. Data were analyzed using descriptive statistics to report complication frequencies. Results: The mean age of patients was 41.03 ± 13.25 years, with a male predominance (55.7%). Among the 97 patients, early postoperative complications were as follows: diabetes insipidus in 10 patients (10.3%), hyponatremia in 8 patients (8.2%), hypopituitarism in 6 patients (6.2%), and CSF leak in 3 patients (3.1%). Conclusion: Endoscopic endonasal transsphenoidal surgery for pituitary adenoma is associated with manageable early postoperative complications. The most frequent were diabetes insipidus and hyponatremia, followed by hypopituitarism and CSF leak. Awareness and prompt management of these complications can improve patient recovery and surgical outcomes.

COMPARISON OF LUMBAR INTERLAMINAR EPIDURAL STEROID VERSUS CAUDAL EPIDURAL STEROID IN TREATMENT OF LUMBAR SPINAL STENOSIS

SY KHAN — 2025-07-14

Background: Lumbar spinal stenosis (LSS) is a common cause of low back pain and disability in adults. Epidural steroid injections are frequently used for symptomatic relief, but the optimal approach remains debated. Objective: To compare clinical outcomes between caudal and interlaminar epidural steroid injections in patients with lumbar spinal stenosis. Study Design: Randomized controlled trial. Setting: Orthopedic Unit I, Mayo Hospital, Lahore, Pakistan. Duration of Study: 02-March-2024 to 02-September-2024. Methods: A total of 416 patients with clinically and radiologically confirmed LSS (Lee Grade 1–3 on MRI) were randomly allocated into two groups. Group A received fluoroscopically-guided interlaminar epidural steroid injections at the L2–L3 level, while Group B received fluoroscopically-guided caudal epidural steroid injections. The Oswestry Disability Index (ODI) and Numeric Pain Rating Scale (NPRS) were assessed at baseline and at 12 weeks post-intervention. Results: At the 12-week follow-up, Group A demonstrated significantly lower mean NPRS scores (2.65 ± 1.084) compared to Group B (3.25 ± 1.332; p = 0.0001). Functional improvement was also greater in Group A, with a lower mean ODI score (13.97 ± 2.045) versus Group B (15.91 ± 3.277; p = 0.0001). Conclusion: Interlaminar epidural steroid injection provided superior pain relief and functional improvement compared to caudal epidural steroid injection in patients with lumbar spinal stenosis.

FREQUENCY OF WOUND INFECTION AMONG PATIENTS UNDERGOING GRAHAM'S OMENTOPEXY IN THE MANAGEMENT OF PERFORATED DUODENAL ULCER

F SHAH — 2025-07-14

Background: A Perforated duodenal ulcer is a surgical emergency associated with significant morbidity, including postoperative wound infection. Graham's omentopexy remains the standard repair technique, but postoperative infection rates vary across populations. Objective: To determine the frequency of wound infection among patients undergoing Graham's omentopexy for the management of perforated duodenal ulcer. Study Design: Cross-sectional study. Setting: Department of Surgery, Saidu Group of Teaching Hospitals, Swat, Pakistan. Duration of Study: 11 October 2024 to 11 April 2025. Methods: Eighty-five patients aged 18–75 years with clinically and radiologically confirmed perforated duodenal ulcers were included. All underwent Graham's omentopexy. Wound infection was assessed on the 7th postoperative day based on clinical criteria. Data on age, gender, diabetes, and hypertension status were collected. Descriptive statistics were calculated using SPSS version 25. Results: The mean age was 40.68 ± 15.99 years. Of the total, 55.3% were male and 44.7% were female. Diabetes mellitus was present in 20% and hypertension in 29.4% of patients. The overall wound infection rate was 23.5%. Conclusion: Wound infection occurred in nearly one-fourth of patients undergoing Graham's omentopexy for perforated duodenal ulcer. These findings highlight the need for targeted infection prevention strategies in this high-risk surgical population.

FREQUENCY OF PULMONARY HYPERTENSION IN HEMODIALYSIS PATIENTS PRESENTING AT TERTIARY CARE HOSPITAL

S KHAN — 2025-07-17

Background: Pulmonary hypertension (PH) is a common and serious cardiovascular complication among patients undergoing hemodialysis. It contributes significantly to increased morbidity and mortality in this population, often remaining underdiagnosed due to a nonspecific clinical presentation. Objective: To determine the frequency of pulmonary hypertension in hemodialysis patients presenting at a tertiary care hospital. Study Design: Cross-sectional descriptive study. Setting: Nephrology Department, Rehman Medical College, Peshawar, Pakistan. Duration of Study: 17-September-2024 to 17-March-2025. Methods: A total of 148 hemodialysis patients aged between 18 and 70 years were enrolled. Pulmonary hypertension was diagnosed using Doppler echocardiography, defined as a mean pulmonary arterial pressure (mPAP) >25 mmHg at rest. Clinical evaluation included assessment of angina (Visual Analogue Scale score >3) and shortness of breath. Data were analyzed using descriptive statistics, and results were expressed as frequencies, percentages, means, and standard deviations. Results: The mean age of the study population was 47.55 ± 16.11 years. Of the 148 patients, 85 (57.4%) were male and 63 (42.6%) were female. Pulmonary hypertension was detected in 76 (51.4%) patients, indicating a high prevalence of cardiovascular complications among individuals on long-term hemodialysis. Conclusion: The study found a high frequency (51.4%) of pulmonary hypertension among hemodialysis patients, emphasizing the need for routine cardiovascular monitoring in this high-risk group to improve clinical outcomes and reduce long-term complications.

COMPARISON OF FETOMATERNAL OUTCOMES OF PUSH VS PULL TECHNIQUE IN SECOND STAGE CESAREAN SECTION

S AWAIS — 2025-07-18

Background: Management of an impacted fetal head during second-stage cesarean section presents significant fetomaternal challenges. Different delivery techniques, such as push and pull, may influence maternal and neonatal outcomes. Objective: To compare fetomaternal outcomes using the push versus pull technique for delivery of the impacted fetal head during second-stage cesarean section. Study Design: Randomized controlled trial. Setting: Conducted at the Department of Gynecology and Obstetrics at Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: 11 February 2025 to 11 May 2025. Methods: A total of 224 pregnant women aged 15–45 years, with gestational age ≥37 weeks, cephalic presentation, singleton pregnancy, and a fully dilated cervix were enrolled. Patients were equally divided into two groups: Group A (n = 112) underwent the push technique, and Group B (n = 112) underwent the pull technique. Fetomaternal outcomes evaluated included uterine incision extension, need for blood transfusion, and neonatal APGAR score <7 at five minutes. Statistical analysis was performed using SPSS, with P < 0.05 considered significant. Results: Mean maternal age was 28.57 ± 7.87 years in Group A and 27.79 ± 8.44 years in Group B. Uterine incision extension occurred in 25.9% of the push group versus 8.9% in the pull group (P = 0.001). Blood transfusion was required in 10.7% of neonates versus 3.6% (P = 0.03), and low APGAR scores (<7) were noted in 16.1% versus 7.1% of neonates in the push and pull groups, respectively (P = 0.03). Conclusion: The pull technique demonstrated superior fetomaternal outcomes compared to the push technique for delivery of impacted fetal heads during second-stage cesarean sections, with lower rates of uterine incision extension, blood transfusion, and neonatal compromise.

EARLY DEATH IN A PEDIATRIC INTENSIVE CARE UNIT OF PAKISTAN: A DESCRIPTIVE ANALYSIS

MR IQBAL — 2025-07-14

Background: Mortality statistics from pediatric intensive care units (PICU) are widely available. Early Death (ED) is defined as death occurring within 24 hours of ICU admission. Few clinical reports on ED are available from the adult ICU. There is a paucity of data on ED available from the PICU. Objective: The objective of the study is to assess the frequency of Early Deaths and describe the patient's clinical-demographic characteristics who died within the first 24 hours of PICU admission. Study Design: A descriptive, cross-sectional study. Setting: A closed multidisciplinary Pediatric Intensive Care Unit of a public-sector Children's Hospital. Duration: One year; From January 1 to December 31, 2024. Methods: A total of 225 children (age 1 month to 15 years) who expired within 24 hours of admission to the PICU of the Children's Hospital of Korangi, Karachi, were eligible. Data were extracted from electronic medical records and chart reviews, including patients' demographic characteristics, pertinent clinical variables, selected labs and imaging, pediatric sequential organ dysfunction (p-SOFA) score, and received ICU-specific intervention. Descriptive statistics were applied. Results: The overall mortality rate was 8.72% (666) of all admissions (n=5814), and 33.78% (225) of all deaths were ED. The median age was 12 months (IQR 6-24 months), and 55% were male. Almost half of the patients (48.5%) were in a terminally ill state. The most common abnormal critical clinical parameters were hypoxia (88%, n=198), hypotension (88%, n=198), and decreased level of consciousness (89.8%, n=202). The mean p-SOFA was 10.6±4. Septic shock, cardiac diseases, and multi-organ failure were the most common diagnoses at the time of death. Vasoactive drugs and mechanical ventilation were used in 99.6% (n=224) and 82.7% (n=186), respectively. The mean time from PICU admission to death was 10.5±9.8 hours. Conclusion: We found the frequency of early deaths was more than one-third of all deaths in the PICU (33.78%). Nearly half of them were futile. Septic shock, cardiac illnesses, and multiorgan failure were the common diagnoses. More comprehensive studies are needed on early deaths from PICUs for critical analysis.

SYMMETRICAL PERIPHERAL GANGRENE IN THE POSTPARTUM PERIOD: A RARE AND DEVASTATING COMPLICATION

MB YASIN — 2025-07-15

Background: Symmetrical Peripheral Gangrene (SPG) is a rare but life-threatening condition marked by ischemic necrosis of extremities without major vessel occlusion. It is often associated with disseminated intravascular coagulation (DIC), sepsis, or vasopressor use. Case Presentation: We report a case of a 35-year-old woman who developed SPG in both feet and the right hand after a spontaneous vaginal delivery at home. She developed fever and abdominal pain one week postpartum and subsequently received intravenous antibiotics and two blood transfusions at a private facility. Shortly after the second transfusion, she developed progressive discoloration and pain in her extremities. She was eventually diagnosed with SPG and underwent a below-knee amputation. Conclusion: This case highlights the importance of early recognition and management of sepsis and coagulopathy in the postpartum period to prevent irreversible complications such as SPG.

AUDIT OF CLINICAL INDICATIONS FOR PRIMARY CESAREAN SECTION IN A TERTIARY CARE HOSPITAL

N QAYYUM — 2025-08-24

Background: Cesarean section (CS) rates are rising globally, with primary cesarean deliveries contributing substantially to maternal and neonatal morbidity. Identifying the leading indications and evaluating labor management practices is essential to improving obstetric care and reducing unnecessary procedures. Objective: To assess the indications for primary cesarean section in a tertiary care hospital. Study Design: Clinical audit. Setting: Department of Obstetrics and Gynecology, Khyber Teaching Hospital, Pakistan. Duration of Study: January 2025 to June 2025. Methods: A total of 150 cases of primary cesarean delivery were prospectively enrolled. Data were collected using standardized case record forms documenting demographic characteristics, labor progression parameters, fetal monitoring methods, surgical indications, and maternal and neonatal outcomes. Statistical analysis was performed using descriptive methods and comparative assessment of labor management practices. Results: Emergency cesarean sections accounted for 80.7% of cases. Fetal distress (41.3%) and VBAC (35.3%) were the most common indications, followed by breech presentation and failed induction. Incomplete partograph documentation was observed in 71.3% of cases, and fetal monitoring methods varied across patients. Maternal complications occurred in 12.0% of cases, while neonatal outcomes revealed 11.3% with low Apgar scores and 10.7% requiring NICU admission. Comparative analysis highlighted significant inconsistencies in the diagnosis of fetal distress and labor management approaches. Conclusion: Fetal distress and VBAC were the leading indications for primary cesarean delivery. The findings underscore the urgent need for standardized fetal monitoring protocols, consistent partograph utilization, and improved labor management strategies to optimize maternal and neonatal outcomes and reduce unnecessary cesarean sections.