Pakistan Journal of Intensive Care Medicine

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 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.

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.

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.

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 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.

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.

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.

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.

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.