Pakistan Journal of Intensive Care Medicine

FREQUENCY AND BACTERIOLOGICAL SPECTRUM OF SPONTANEOUS BACTERIAL PERITONITIS IN PATIENTS PRESENTING WITH DECOMPENSATED CIRRHOSIS TO A TERTIARY CARE HOSPITAL

M SALMAN — 2025-04-17

Background: Spontaneous bacterial peritonitis (SBP) is a severe and common infection in patients with decompensated cirrhosis, contributing significantly to morbidity and mortality. Early identification and understanding of causative organisms are crucial for targeted therapy and better patient outcomes. Objective: To assess the frequency of spontaneous bacterial peritonitis and the distribution of bacterial pathogens in patients presenting with decompensated cirrhosis. Study Design: Cross-sectional study. Setting: The study was conducted at the Department of General Medicine, MTI-Lady Reading Hospital, Peshawar. Duration of Study: 13 December 2024 to 13 March 2025. Methods: A total of 101 patients with decompensated cirrhosis were enrolled. Ascitic fluid analysis was performed to diagnose SBP based on polymorphonuclear leukocyte (PMN) count ≥250 cells/mm³ and positive bacterial cultures. Patient demographics, clinical history, and ascitic fluid findings were recorded in a standardized proforma. Data were analyzed using SPSS version 22.0. Frequencies and percentages were calculated for categorical variables, and associations were explored descriptively. Results: SBP was diagnosed in 21 patients (20.8%) with elevated PMN counts. The most commonly isolated organisms were Escherichia coli (52.4%), Klebsiella species (19.0%), Streptococcus pneumoniae (14.3%), and Enterococcus species (9.5%). Males represented 58.4% of the study population and had a higher incidence of SBP. The age group 36–50 years and patients with symptom duration >6 months showed a higher prevalence of SBP. Conclusion: The prevalence of spontaneous bacterial peritonitis among patients with decompensated cirrhosis was 20.8%. E. coli was the most frequently isolated pathogen, followed by Klebsiella and Enterococcus. These findings highlight the importance of prompt diagnostic paracentesis and pathogen-specific antibiotic therapy in cirrhotic patients to improve outcomes.

ATRIAL FIBRILATION FOLLOWING MITRAL VALVE REPLACEMENT FOR MITRAL STENOSIS: A CROSS-SECTIONAL STUDY

MO KHAN — 2025-05-10

Background: Atrial fibrillation (AF) is a frequent and serious postoperative complication in patients undergoing mitral valve replacement (MVR), especially in those with underlying mitral stenosis (MS). Postoperative AF increases the risk of morbidity, prolongs hospital stays, and is associated with elevated mortality. Early identification of risk factors is crucial for optimizing patient outcomes. Objective: To assess the incidence of postoperative atrial fibrillation in patients undergoing MVR for mitral stenosis and evaluate its association with clinical characteristics and outcomes. Study Design: Observational study. Setting: Cardiac Surgery Department of National Institute of Cardiovascular Diseases, Karachi, Pakistan. Duration of Study: January 2024 to January 2025. Methods: A total of 60 patients aged 18–70 years undergoing mitral valve replacement (MVR) for moderate to severe mitral stenosis were enrolled. Postoperative atrial fibrillation (AF) was identified through continuous electrocardiogram (ECG) monitoring during hospitalization. Data were collected on age, sex, comorbidities (diabetes mellitus and hypertension), prior mitral valve replacement (MVR), left atrial diameter, and left ventricular ejection fraction (LVEF). Postoperative outcomes included length of hospital stay, renal failure, and mortality. Statistical analysis was performed using chi-square and independent t-tests. A p-value < 0.05 was considered statistically significant. Results: Postoperative AF developed in 10 out of 60 patients (16.7%). Patients who developed AF were more likely to be over 50 years of age (90% vs. 48%, p = 0.01), have diabetes (80% vs. 18%, p < 0.0001), hypertension (80% vs. 22%, p < 0.0001), and a history of prior MVR (50% vs. 12%, p = 0.005). Left atrial enlargement (≥40 mm) and reduced LVEF (<50%) were significantly more common in the AF group (80% vs. 30%, p = 0.003; and 90% vs. 28%, p < 0.0001, respectively). Postoperative AF was significantly associated with extended hospital stay (>7 days: 80% vs. 22%, p < 0.0001), and increased mortality (70% vs. 2%, p < 0.0001). Conclusion: Postoperative atrial fibrillation is a common complication following MVR for mitral stenosis, with an incidence of 16.7%. It is significantly associated with advanced age, diabetes, hypertension, prior valve surgery, left atrial enlargement, and reduced LVEF. Its occurrence leads to worse clinical outcomes hospital stays and higher mortality. These findings underscore the need for careful preoperative risk assessment and targeted perioperative management strategies to mitigate the incidence and impact of postoperative AF.

INVESTIGATING THE LINK BETWEEN SLEEP APNEA AND CARDIOVASCULAR DISEASE PROGRESSION: A LONGITUDINAL STUDY

A MUNEEB — 2025-03-30

Background: Obstructive sleep apnea (OSA) is increasingly acknowledged as an independent risk factor for cardiovascular disease (CVD), mainly due to intermittent hypoxia, systemic inflammation, and sympathetic overactivity. Despite its clinical significance, there is a scarcity of longitudinal data from South Asia, particularly Pakistan, assessing CVD progression about OSA severity. Objective: To investigate the relationship between the severity and progression of obstructive sleep apnea (OSA) and cardiovascular disease. Study Design: Prospective longitudinal study. Setting: This study was conducted at a tertiary care hospital in Pakistan. Duration of Study: April 2023 to October 2023, (enrollment), with a 12-month follow-up period for each participant. Methods: A total of 78 adults with newly diagnosed moderate to severe obstructive sleep apnea (Apnea-Hypopnea Index [AHI] ≥15), confirmed through polysomnography, were enrolled. Participants were followed for 12 months, during which cardiovascular parameters—including systolic and diastolic blood pressure, lipid profile, high-sensitivity C-reactive protein (hs-CRP), and cardiovascular events (such as myocardial infarction and angina)—were monitored. Data were analyzed using SPSS version 26. Statistical tests included paired t-tests, chi-square tests, and logistic regression; p-values less than 0.05 were considered statistically significant. Results: Over the 12-month follow-up, there were statistically significant increases in: Systolic blood pressure (mean +6.7 mmHg, p = 0.01), Diastolic blood pressure (mean +4.2 mmHg, p = 0.03), LDL cholesterol levels (p = 0.04), hs-CRP levels (p < 0.01), Cardiovascular events occurred more frequently in the severe OSA group (8 events) than in the moderate OSA group (3 events). Severe OSA and elevated hs-CRP levels (≥5 mg/L) were identified as independent predictors of cardiovascular events with odds ratios (OR) of 3.8 and 4.1, respectively. Conclusion: Severe obstructive sleep apnea significantly contributes to cardiovascular disease progression in the Pakistani population, likely mediated through inflammatory and hypertensive mechanisms. Early detection and management of OSA may offer a strategic opportunity to mitigate long-term cardiovascular risks.

FREQUENCY OF URINARY TRACT INFECTION IN STROKE PATIENTS WITH INDWELLING CATHETER AT LADY READING HOSPITAL PESHAWAR

A SHAHI — 2025-05-11

Background: Urinary tract infection (UTI) is a common complication in stroke patients, especially those with indwelling urinary catheters. These infections can significantly impact patient outcomes and prolong hospital stays. Identifying risk factors can guide preventive strategies. Objective: To evaluate the frequency of urinary tract infection (UTI) frequency in stroke patients with indwelling catheters and identify associated risk factors. Study Design: Cross-sectional observational study. Setting: Department of Medicine, Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: Six months (12-November-2023—12-May-2024). Methods: A total of 111 stroke patients aged 30–70 years with indwelling urinary catheters were enrolled. UTI was diagnosed based on urine culture showing bacterial growth >10⁵ CFU/mL, specifically of Escherichia coli, Klebsiella, or Pseudomonas species. Data on demographics, hospital stay duration, and gender were collected. Statistical analysis was performed using the chi-square test with significance set at p < 0.05. Results: The mean age of participants was 46.91 ± 10.68 years. UTIs were diagnosed in 21.6% of patients. Notably, UTI occurrence was significantly higher in patients aged >50 years (79.2%, p = 0.0001), females (83.3%, p = 0.0001), and those with prolonged hospital stays (75%, p = 0.002). Conclusion: The frequency of UTI in stroke patients with indwelling urinary catheters was 21.6%. Risk factors significantly associated with UTI included older age, female gender, and prolonged hospitalization. Preventive strategies targeting these risk groups may help reduce infection rates in this population.

COMPARISON OF CSF LEAK IN NEONATES UNDERGOING MENINGOMYELOCELE REPAIR WITH AND WITHOUT VENTRICULOPERITONEAL SHUNT DONE IN A TERTIARY CARE HOSPITAL

B ULLAH — 2025-04-05

Background: Cerebrospinal fluid (CSF) leakage is a significant complication following meningomyelocele (MMC) repair, potentially leading to infections and poor surgical outcomes. The role of ventriculoperitoneal (VP) shunt placement in reducing CSF leaks remains a topic of debate. Understanding the impact of VP shunts on CSF leak rates can help optimize neurosurgical management strategies in neonates undergoing MMC repair. Objective: To compare the incidence of CSF leaks in neonates undergoing MMC repair with and without VP shunt placement. Study Design: Descriptive analysis. Setting: The study was conducted in the Department of Neurosurgery at Lady Reading Hospital, Peshawar. Duration of Study: This study was conducted from August 04, 2024, to February 04, 2025. Methods: A total of 100 neonates (aged 1 to 28 days) diagnosed with MMC were enrolled. Exclusion criteria included neonates with a low Apgar score (less than 5) and those whose parents declined consent. All neonates underwent standard neurosurgical closure of the MMC defect within 24 hours of admission. Patients were categorized into two groups: those who received a VP shunt (n = 72) and those who did not (n = 28). CSF leaks were assessed clinically based on the presence of osseous defects with fluid leakage. The incidence of CSF leaks was compared between the two groups using statistical analysis. A p-value of less than 0.05 was considered statistically significant. Results: The mean age of neonates was 13.73 ± 8.22 days. Among the 100 neonates, VP shunts were placed in 72, while 28 did not receive shunts. The overall incidence of CSF leaks was 9%. A significant difference in CSF leak rates was observed between the groups: only 2.8% of neonates with VP shunts developed CSF leaks compared to 25% of those without VP shunts (p = 0.0001), indicating a strong protective effect of VP shunt placement. Conclusion: This study demonstrates that VP shunt placement significantly reduces the incidence of CSF leaks in neonates undergoing MMC repair. Neonates who did not receive VP shunts had a markedly higher rate of CSF leaks, highlighting the potential benefit of early VP shunt placement in improving postoperative outcomes. Further studies with larger cohorts are warranted to validate these findings and guide clinical decision-making.

DEPRESSION, ANXIETY AND STRESS AMONG FEMALES UNDERGOING CESAREAN SECTION IN TERTIARY CARE HOSPITAL

S ASLAM — 2025-06-10

Background: Cesarean section (CS) is a prevalent surgical procedure employed to avert obstetric complications. However, it is frequently accompanied by psychological sequelae including depression, anxiety, and stress. These concerns are especially pronounced in low-resource settings such as Pakistan, where routine mental health screening is often neglected in perinatal care. Objective: To determine the prevalence and severity of depression, anxiety, and stress among women undergoing cesarean section and to explore their association with demographic and obstetric variables. Study Design: Descriptive cross-sectional study. Settings: Department of Obstetrics and Gynaecology, Sheikh Zayed Hospital, Lahore, Pakistan. Duration of Study: Six months from July to December 2024. Methods: A total of 160 pregnant women undergoing elective or emergency cesarean section were enrolled through non-probability purposive sampling. Data were collected via a structured questionnaire incorporating the Depression, Anxiety, and Stress Scale-21 (DASS-21). Statistical analysis was performed using SPSS version 23. Descriptive statistics were used to summarize participant characteristics and DASS-21 scores. Chi-square tests were applied to examine associations between psychological outcomes and demographic/obstetric variables, with significance set at p < 0.05. Results: The mean age of participants was 27.67 ± 5.03 years. The prevalence of depression, anxiety, and stress was 40%, 60%, and 35%, respectively, with mean scores indicating moderate severity. Statistically significant associations were observed between psychological distress and variables such as age, education level, body mass index, type of family structure, nature of cesarean (elective vs emergency), and the presence of pregnancy-related complications (p < 0.05). Conclusion: A considerable proportion of women undergoing cesarean sections experience clinically significant psychological distress. Integrating routine psychological screening and timely mental health support into obstetric care protocols is imperative for improving maternal and neonatal outcomes in resource-limited settings

FREQUENCY OF THYROID DYSFUNCTION AMONG TYPE 2 DIABETES MELLITUS PATIENTS PRESENTING TO SAIDU GROUP OF TEACHING HOSPITAL

S HUSSAIN — 2025-05-10

Background: Thyroid dysfunction is a common comorbidity in patients with type 2 diabetes mellitus (T2DM), potentially exacerbating metabolic imbalance and complicating disease management. Early identification of thyroid abnormalities can help optimize clinical outcomes in diabetic patients. Objective: To evaluate the frequency of thyroid dysfunction among patients with T2DM presenting to Saidu Teaching Hospital, Swat, and to assess its association with demographic and clinical factors such as age, gender, body mass index (BMI), and hypertension. Study Design: Cross-sectional study. Setting: Saidu Teaching Hospital, Swat, Pakistan. Duration of Study: 09 April 2023 to 09 October 2023. Methods: 222 patients aged 18–70 with type 2 diabetes mellitus (HbA1c >6.5%) were enrolled. Thyroid dysfunction was assessed via thyroid-stimulating hormone (TSH) levels, with hypothyroidism defined as TSH >4.5 mU/L and hyperthyroidism as TSH <0.4 mU/L. Demographic and clinical variables, including age, gender, BMI, and hypertension status, were recorded. Statistical analysis was performed using SPSS version 26, with chi-square tests used to assess associations. A p-value <0.05 was considered statistically significant. Results: The mean age of participants was 46.60 ± 14.03 years, with a majority being male (55.9%). Thyroid dysfunction was observed in 11.7% of patients. A significantly higher frequency of dysfunction was found in patients aged >50 years (73.1%, p=0.001), females (61.5%, p=0.05), and those with elevated BMI >24.9 kg/m² (76.9%, p=0.001). No significant association was found with hypertension. Conclusion: The frequency of thyroid dysfunction in patients with T2DM was 11.7%, with significant associations observed with older age, female gender, and elevated BMI. Routine screening for thyroid dysfunction in diabetic patients, especially those with these risk factors, is recommended to improve clinical management.

DIAGNOSTIC ACCURACY OF ELASTOGRAPHY IN PREDICTING MALIGNANT THYROID TUMOR WHILE TAKING HISTOPATHOLOGY AS GOLD STANDARD IN PATIENTS PRESENTING TO LADY READING HOSPITAL PESHAWAR

M AHMAD — 2025-03-26

Background: Thyroid nodules are a common clinical finding, with a subset harboring malignancy. Strain elastography has emerged as a promising non-invasive imaging modality for assessing thyroid nodules. However, histopathology remains the gold standard for a definitive diagnosis. Evaluating the diagnostic accuracy of strain elastography can aid in improving preoperative assessment and reducing unnecessary biopsies. Objective: To assess the diagnostic accuracy of strain elastography in detecting malignant thyroid nodules, using histopathology as the gold standard. Study Design: Cross-sectional validation study. Setting: Radiology Department, Lady Reading Hospital, Peshawar. Duration of Study: 27 August 2023 to 27 February 2024. Methods: A total of 110 patients aged 18 to 70 years with palpable thyroid nodules were included using consecutive sampling. Patients with prior thyroid surgery, chronic kidney disease, or pregnancy were excluded. Strain elastography was performed using a 7.5 MHz linear probe, with malignancy suspected based on features such as microcalcifications and irregular borders. Histopathological examination served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated using a 2×2 contingency table. Statistical analysis was performed using SPSS version 21. Results: The study population had a mean age of 41.22 ± 15.08 years and a mean body mass index (BMI) of 25.75 ± 1.80 kg/m². Female patients comprised 54.5% of the cohort, while males accounted for 45.5%. Strain elastography identified malignancy in 53 patients (48.2%), whereas histopathology confirmed malignancy in 51 patients (46.4%). Among elastography-positive cases, 45 were true positives, and 8 were false positives. Among elastography-negative cases, 51 were true negatives, and 6 were false negatives. The diagnostic performance of strain elastography was as follows: Sensitivity: 88.24%, Specificity: 86.44%, Positive Predictive Value (PPV): 84.91%, Negative Predictive Value (NPV): 89.47%, Diagnostic Accuracy: 87.27%, Conclusion: Strain ultrasound elastography demonstrated high diagnostic accuracy in identifying malignant thyroid nodules, making it a reliable, non-invasive tool for clinical decision-making. Its integration into routine thyroid nodule assessment can enhance early detection while reducing unnecessary biopsies. Future research should focus on incorporating quantitative elastography techniques to refine diagnostic precision further.

FACTORS AFFECTING THE DIAGNOSTIC YIELD OF ENDOSCOPIC ULTRASOUND GUIDED BIOPSY OF SUB EPITHELIAL LESIONS IN GASTROINTESTINAL TRACT

A LIAQAT — 2025-06-08

Background: Subepithelial lesions (SELs) of the gastrointestinal (GI) tract are often incidental findings during endoscopy, and their evaluation can be challenging. Endoscopic ultrasound-guided biopsy (EUS-GEB) has emerged as a key diagnostic tool for obtaining tissue samples from SELs, yet its diagnostic yield varies due to multiple procedural and lesion-related factors. Objective: To evaluate the factors influencing the diagnostic yield of endoscopic ultrasound-guided biopsy (EUS-GEB) in the assessment of gastrointestinal subepithelial lesions. Study Design: Descriptive study. Setting: Hayatabad Medical Complex, Peshawar, Pakistan. Duration of Study: July 2024 to January 2025. Methods: A total of 60 patients who underwent EUS-GEB for SELs in the gastrointestinal tract were included. Clinical and procedural data were collected, including lesion size, location, echogenicity, needle size, number of needle passes, and endoscopist experience. Histopathological evaluation was conducted on all biopsy samples. Diagnostic yield was defined as the percentage of procedures resulting in a definitive histological diagnosis. Statistical analyses were performed using appropriate tests to identify significant predictors of diagnostic yield. Results: Among the 60 patients enrolled, most lesions were located in the stomach (63.3%) and esophagus (18.3%). The overall diagnostic yield was 68.3%. Lesions larger than 20 mm, more than three needle passes, and procedures performed by more experienced endoscopists were significantly associated with higher diagnostic yield (p < 0.05). Conclusion: Lesion size, the number of needle passes, and endoscopist experience are key factors that significantly affect the diagnostic yield of EUS-GEB in evaluating subepithelial lesions of the GI tract. Optimizing these variables may improve diagnostic accuracy and clinical outcomes.

IN HOSPITAL OUTCOMES IN PATIENTS PRESENTING WITH ACUTE DECOMPENSATED HEART FAILURE WITH HYPONATREMIA

M PARVEZ — 2025-04-30

Background: Acute decompensated heart failure (ADHF) is characterized by the rapid onset or worsening of symptoms and signs of heart failure, often necessitating urgent hospitalization. Its prevalence continues to rise globally, significantly contributing to increased morbidity and mortality. Objective: To determine the in-hospital outcomes among patients presenting with acute decompensated heart failure and concomitant hyponatremia.
Study Design: Descriptive case series. Settings: Department of Cardiology, MTI-Hayatabad Medical Complex, Peshawar. Duration of Study: From 14 June 2022 to 14 December 2022. Methods: Patients meeting the predefined inclusion criteria were prospectively enrolled after obtaining informed written consent from the patients or their caregivers. Clinical assessments and serum sodium levels were monitored during hospitalization, and relevant in-hospital outcomes, including mortality, length of hospital stay, and rehospitalization rates, were meticulously documented. Results: Out of the enrolled cohort, 113 (71.5%) patients had a previous history of hyponatremia. During hospitalization, 54 (34.2%) patients died, 42 (26%) required hospital stays longer than six days, and 32 (20.3%) were rehospitalized after initial discharge. Conclusion: The presence of hyponatremia in patients hospitalized for ADHF at MTI-HMC was strongly associated with adverse clinical outcomes, including high mortality, prolonged hospitalization, and rehospitalization. Therefore, routine monitoring and management of serum sodium levels are strongly recommended for patients admitted with acute heart failure.

FREQUENCY AND FACTORS OF HEMORRHAGIC TRANSFORMATION IN PATIENTS WITH ISCHEMIC STROKE

Z AHMAD — 2025-03-20

Background: Hemorrhagic transformation (HT) is a serious complication of ischemic stroke that can significantly impact clinical outcomes. Identifying its frequency and associated risk factors is crucial for improving patient management and reducing morbidity and mortality. Understanding these risk factors may help in developing targeted preventive strategies and optimizing stroke treatment protocols. Objective: To determine the frequency of hemorrhagic transformation in ischemic stroke patients and to identify the associated risk factors contributing to its occurrence. Study Design: Descriptive study. Setting: The study was conducted in the Department of Neurology at Fauji Foundation Hospital in Rawalpindi. Duration of Study: This study was carried out from 11 July 2024 to 11 January 2025. Methods: A total of 180 ischemic stroke patients were enrolled in the study. Demographic data, medical history, and risk factors—including hypertension, diabetes, hyperlipidemia, ischemic heart disease, and smoking—were recorded. The frequency of HT was assessed using imaging modalities. Patient characteristics such as age, gender, and ICU admission were also analyzed. Statistical analyses, including chi-square and logistic regression, were performed to determine significant risk factors for HT, with a significance level set at p ≤ 0.05. Results: Among the 180 ischemic stroke patients, 17 (9.4%) developed HT. The most prevalent risk factors in the HT group were hypertension (70.6%), diabetes (58.8%), hyperlipidemia (41.2%), ischemic heart disease (23.5%), and smoking (41.2%). An age-related trend was observed, with the highest incidence of HT occurring in the 61–80 years age group (58.8%). Additionally, patients with HT had a higher ICU admission rate (35.3%) compared to those without HT (8.0%). Conclusion: This study highlights a significant association between hypertension, diabetes, hyperlipidemia, ischemic heart disease, and smoking with the development of hemorrhagic transformation in ischemic stroke patients. Early detection and management of these risk factors are essential in mitigating HT risk and improving patient outcomes. Close monitoring and individualized treatment strategies should be prioritized, particularly for high-risk patients, to reduce the likelihood of severe HT complications.

PROGNOSTIC ACCURACY OF CEREBROPLACENTAL RATIO FOR ADVERSE FETAL OUTCOMES AND FETAL DISTRESS WITHIN 24 HOURS OF BIRTH

S MUSHTAQ — 2025-06-25

Background: The cerebroplacental ratio (CPR), derived from Doppler indices of the fetal middle cerebral artery and umbilical artery, has emerged as a potential predictor of fetal compromise. Evaluating its prognostic accuracy for adverse perinatal outcomes (APO) and cesarean section for intrapartum fetal distress (CS-IFR) may enhance perinatal risk stratification and decision-making in late gestation. Objective: To evaluate the prognostic accuracy of the cerebroplacental ratio for predicting adverse perinatal outcomes and cesarean section due to fetal distress within 24 hours of delivery. Study Design: Retrospective observational study. Setting: Radiology and Gynaecology Departments, Nishtar Hospital, Multan, Pakistan. Duration of Study: Twelve months, from April 2024 to April 2025. Methods: A total of 200 pregnant women between 31 and 41 weeks of gestation were included. All participants underwent fetal ultrasound assessment for estimated fetal weight, amniotic fluid volume, and Doppler evaluation of the umbilical artery (UA) and middle cerebral artery (MCA). The cerebroplacental ratio (CPR) was calculated as the MCA pulsatility index divided by the UA pulsatility index. Neonatal outcomes were recorded within 24 hours of delivery. Statistical analyses included chi-square tests and multiple regression analysis to determine the association between CPR and adverse outcomes. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CPR were calculated. Results: Patients with elevated UA pulsatility index and higher UA-PI multiples of the median showed a significantly higher incidence of adverse perinatal outcomes (p = 0.009). Multiple regression analysis identified labor induction (OR: 2.48, 95% CI: 1.019–6.11, p < 0.05) and CPR multiples of the median (OR: 0.03, 95% CI: 0.0071–0.3261, p < 0.001) as independent predictors of adverse perinatal outcomes. CPR showed a specificity of 70%, PPV of 32%, and NPV of 94% for predicting APO. For predicting CS-IFR, CPR had a specificity of 79%, a PPV of 26%, and NPV of 98%. Conclusion: The cerebroplacental ratio is a strong and reliable predictor of adverse perinatal outcomes and cesarean delivery for fetal distress in term pregnancies. Its high negative predictive value suggests utility in identifying low-risk pregnancies and informing delivery planning.

EFFICACY AND SAFETY OF PYODINE-IODINE PLEURODESIS IN MALIGNANT PLEURAL EFFUSION

F KHAN — 2025-05-10

Background: Malignant pleural effusion (MPE) is a common complication of advanced malignancies, leading to significant morbidity due to symptoms such as dyspnea and cough. Chemical pleurodesis is a widely used palliative procedure for managing recurrent MPE. Povidone-iodine, an easily available and cost-effective agent, has been suggested as an alternative sclerosing agent with promising results. Objective: To evaluate the efficacy and safety of povidone-iodine pleurodesis in patients with malignant pleural effusion. Study Design: Quasi-experimental design. Setting: Department of Pulmonology, Saidu Group of Teaching Hospital, Swat, Pakistan. Duration of Study: 02-December-2024 to 02-April-2025. Methods: 157 patients aged between 18 and 65 with confirmed MPE were enrolled. All patients underwent pleurodesis using 20 mL of 10% povidone-iodine mixed with 40 mL normal saline, administered via a 28-French chest tube placed in the sixth intercostal space. Efficacy was assessed by clinical symptom resolution (dyspnea and cough) and radiographic clearance of pleural effusion at six weeks post-procedure. Safety was evaluated by monitoring for adverse events, including fever (≥38.0°C), nausea, and dizziness. Data were analyzed using SPSS version 24, with descriptive statistics reported. Associations were assessed with chi-square tests where appropriate (p-value < 0.05 considered significant). Results: The mean age of patients was 44.81 ± 13.37 years. The overall efficacy rate of pleurodesis was 86.6%. Fever occurred in 22.9% of patients, nausea in 17.8%, and dizziness in 9.6%. Safety was maintained in 84.1% of cases, indicating a favorable tolerance profile. Conclusion: Povidone-iodine pleurodesis demonstrated high efficacy and a favorable safety profile in managing malignant pleural effusions, offering an effective, affordable, and well-tolerated option for palliation with minimal complications.

FREQUENCY OF DYSLIPIDEMIA IN PATIENTS WITH THYROID DYSFUNCTION PRESENTING AT SAIDU GROUP OF TEACHING HOSPITAL

MK HABIB — 2025-01-29

Background: Thyroid dysfunction is known to affect lipid metabolism, increasing the risk of cardiovascular diseases. Dyslipidemia is frequently observed in both hypothyroid and hyperthyroid patients, but its prevalence and associated risk factors vary across populations. Understanding this association can help optimize management strategies for patients with thyroid disorders. Objective: To determine the frequency of dyslipidemia in patients with thyroid dysfunction and to explore its association with demographic and clinical factors. Study Design: Cross-sectional study. Setting: Department of General Medicine, Saidu Group of Teaching Hospital, Swat. Duration of Study: Six months (21-03-2024 to 21-09-2024). Methods: 130 patients aged 20–70 with thyroid dysfunction were included using consecutive non-probability sampling. Thyroid dysfunction was defined as hyperthyroidism (serum TSH <0.4 mU/L) or hypothyroidism (serum TSH >4.5 mU/L). Patients with pre-existing cardiovascular or renal diseases, as well as pregnant or lactating women, were excluded. Lipid profiles were assessed, and the frequency of dyslipidemia was determined. Data were analyzed using SPSS version 25, and associations between dyslipidemia and demographic/clinical factors were evaluated using the Chi-square test. A p-value ≤0.05 was considered statistically significant. Results: The prevalence of dyslipidemia among patients with thyroid dysfunction was 38.5%. Dyslipidemia was significantly associated with comorbidities such as hypertension (66% in dyslipidemic vs. 26.2% in non-dyslipidemic patients, p<0.05) and diabetes (66% vs. 27.5%, p<0.05). The highest prevalence of dyslipidemia was observed in older adults (51–70 years, 62%). A slight female predominance (55.4%) was noted, aligning with the higher prevalence of thyroid disorders in women. Conclusion: Dyslipidemia is common in patients with thyroid dysfunction, particularly among older individuals and those with hypertension or diabetes. These findings highlight the need for routine lipid screening and early intervention in patients with thyroid disorders to mitigate cardiovascular risks.

HYDROCEPHALUS IN CEREBELLOPONTINE ANGLE TUMORS: EVALUATING THE ROLE OF VENTRICULOPERITONEAL SHUNTS

ZU REHMAN — 2025-06-10

Background: Hydrocephalus is a frequent and serious complication of cerebellopontine angle (CPA) tumors due to cerebrospinal fluid (CSF) flow obstruction. Ventriculoperitoneal (VP) shunting is commonly used to relieve intracranial pressure, but comprehensive outcome evaluations, including neurological and quality-of-life (QoL) parameters, remain limited. Objective: To evaluate the efficacy of ventriculoperitoneal shunting in managing hydrocephalus associated with CPA tumors, focusing on intracranial pressure (ICP), neurological status, and quality of life. Study Design: Prospective observational study. Setting: Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: Four years, from January 2020 to December 2023. Methods: A total of 190 patients diagnosed with hydrocephalus secondary to CPA tumors were included. All patients underwent ventriculoperitoneal shunt placement. Clinical outcomes were assessed using intracranial pressure (ICP) measurements, Glasgow Coma Scale (GCS) scores, and the Short Form-36 (SF-36) quality of life survey. Data were recorded preoperatively and at 1, 3, and 6 months postoperatively. Statistical analysis was performed using SPSS version 25.0. Paired t-tests were used to evaluate pre- and postoperative differences, with p < 0.05 considered statistically significant. Results: The mean age of patients was 45.3 ± 12.4 years. Males constituted 55.3% and females 44.7% of the study population. Following VP shunting, a significant reduction in mean ICP was observed from 25.4 ± 5.1 mmHg to 12.7 ± 3.8 mmHg (p < 0.001). Mean GCS scores improved from 9.2 ± 3.5 preoperatively to 13.6 ± 2.1 postoperatively (p < 0.001). SF-36 QoL scores increased markedly from 40.5 ± 15.3 to 75.2 ± 10.7 (p < 0.001). Additionally, hospital readmission rates declined from 20% preoperatively to 5% postoperatively (p < 0.01). Conclusion: Ventriculoperitoneal shunting is an effective intervention for managing hydrocephalus in patients with CPA tumors, significantly reducing intracranial pressure and improving neurological function and quality of life.

COMPARISON BETWEEN NEONATAL OUTCOME OF VAGINAL DELIVERY AND CAESAREAN SECTION FOR BREECH PRESENTATION

N MUSLIM — 2025-04-30

Background: Breech presentation at term poses a significant obstetric challenge, often associated with increased neonatal morbidity. The mode of delivery in such cases remains a topic of clinical debate, with cesarean section usually preferred to minimize neonatal complications. However, comparative data on neonatal outcomes between vaginal and cesarean deliveries for breech presentations are still evolving, especially in resource-limited settings. Objective: To compare neonatal outcomes, specifically low Apgar scores, between vaginal delivery and cesarean section in term breech presentations. Study Design: Descriptive cross-sectional study. Setting: Conducted at the Department of Obstetrics & Gynecology, Saidu Group of Teaching Hospital, Swat, Pakistan. Duration of Study: 21-07-2024 to 21-01-2025. Methods: A total of 145 women aged 18–40 years with singleton term pregnancies (37–41 weeks) presenting with breech were included. Participants underwent either vaginal delivery or cesarean section. Neonatal outcome was assessed based on the Apgar score at 5 minutes, with a score <7 considered low. Data analysis was conducted using SPSS version 24. Categorical variables were compared using the chi-square test, with a p-value ≤ 0.05 considered statistically significant. Results: Of the 145 participants, 49 (33.8%) underwent vaginal delivery and 96 (66.2%) had cesarean sections. A significantly higher proportion of neonates delivered vaginally had low Apgar scores at 5 minutes (14.3%) compared to those delivered via cesarean section (4.2%) (p = 0.02). Conclusion: Elective cesarean section for term breech presentation is associated with improved neonatal outcomes, as evidenced by a significantly lower incidence of low Apgar scores compared to vaginal delivery. These findings support the consideration of cesarean delivery as a safer option for breech presentations at term.

FETOMATERNAL OUTCOMES OF ECLAMPSIA AT LIAQUAT MEMORIAL TEACHING HOSPITAL KOHAT

N HUSSAIN — 2025-02-28

Background: Eclampsia remains a significant cause of maternal and fetal morbidity and mortality, particularly in resource-limited settings. Delays in diagnosis, inadequate antenatal care, and suboptimal management contribute to poor outcomes. Understanding the factors influencing fetomaternal outcomes can help improve management strategies and reduce complications. Objective: To evaluate the fetomaternal outcomes of eclamptic patients managed at Liaquat Memorial Teaching Hospital, Kohat, and identify preventable factors contributing to adverse outcomes. Study Design: Descriptive cross-sectional study. Setting: Liaquat Memorial Teaching Hospital, Kohat. Duration of Study: Six months (08/06/2024—08/12/2024). Methods: A total of 83 eclamptic patients diagnosed between 24 weeks of gestation and 42 days postpartum were included. Data collection involved detailed medical histories, physical examinations, and fetal monitoring. Standard management protocols included magnesium sulfate for seizure control, antihypertensive therapy, and obstetric interventions based on clinical assessment. Maternal outcomes assessed included acute kidney injury (AKI), pulmonary edema, and maternal mortality. Fetal outcomes recorded were intrauterine growth restriction (IUGR), preterm birth, and fetal mortality. Data analysis was performed using SPSS version 25, with descriptive statistics applied to assess frequencies and percentages. Results: The mean maternal age was 31.34 ± 6.643 years, with an average gestational age of 35.95 ± 2.85 weeks. Pre-eclamptic signs were observed in 83.1% of patients. Maternal complications included AKI in 4.8% of cases, pulmonary edema in 6.0%, and a maternal mortality rate of 7.2%. Among fetal outcomes, 47.0% of cases exhibited IUGR, while 49.4% were preterm births. Fetal mortality was recorded at 8.4%, with 91.6% of neonates surviving. Conclusion: Eclampsia remains a critical contributor to maternal and fetal morbidity and mortality. Early diagnosis, effective management, and enhanced antenatal care are essential for improving outcomes. Reducing delays in detection and referral, particularly in resource-constrained settings, is crucial to minimizing complications and enhancing maternal and neonatal survival.

FREQUENCY OF HYPERNATREMIA SECONDARY TO ACUTE GASTROENTERITIS IN CHILDREN UNDER FIVE YEARS OF AGE

H MIR — 2025-06-15

Background: Acute gastroenteritis remains a leading cause of morbidity and mortality among children under five years of age in developing countries. Electrolyte imbalances, particularly hypernatremia, can complicate its clinical course and may significantly increase the risk of adverse outcomes if not promptly identified and managed. Objective: To determine the frequency and severity of hypernatremia secondary to acute gastroenteritis in children under five years of age. Study Design: Cross-sectional study. Setting: Pediatric Department, Northwest General Hospital, Peshawar, Pakistan. Duration of Study: Three months, from February 7, 2025, to May 7, 2025. Methods: A total of 121 children under the age of five years presenting with acute gastroenteritis were enrolled using a consecutive sampling technique. Serum sodium levels were measured upon admission. Hypernatremia was categorized into three levels of severity: mild (146–149 mmol/L), moderate (150–169 mmol/L), and severe (≥170 mmol/L). Data were analyzed using SPSS version 25.0. Descriptive statistics were used to calculate frequencies, percentages, means, and standard deviations. Results: The mean age of the participants was 2.50 ± 1.17 years. Of the 121 children, 57.0% were male and 43.0% were female. Hypernatremia was observed in 21 patients (17.4%). Among those with hypernatremia, 14.3% had mild, 52.4% had moderate, and 33.3% had severe hypernatremia. Conclusion: Hypernatremia was present in 17.4% of children under five years of age with acute gastroenteritis, with the majority presenting in the moderate severity category. Early detection and appropriate management of electrolyte imbalances are critical to improving clinical outcomes in pediatric gastroenteritis cases.

COMPARISON OF ALT LEVELS IN TYPE 2 DIABETIC PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE ACCORDING TO THEIR GLYCEMIC CONTROL

Z KHAN — 2025-04-24

Background: Non-alcoholic fatty liver disease (NAFLD) is a common comorbidity in patients with type 2 diabetes mellitus (T2DM) and is often associated with elevated alanine aminotransferase (ALT) levels, reflecting hepatic inflammation. Poor glycemic control has been linked to worsening liver pathology, but the relationship between glycemic control and liver enzyme elevation in NAFLD remains to be clarified. Objective: To assess the differences in elevated ALT levels between well-controlled and poorly controlled type 2 diabetic patients with NAFLD. Study Design: Descriptive cross-sectional study. Setting: Department of Medicine at Khyber Teaching Hospital in Peshawar. Duration of Study: The study was conducted over six months from 11 February 2024 to 11 August 2024. Methods: 98 patients aged 30 to 70 years with confirmed T2DM and NAFLD were enrolled and divided into groups based on glycemic control: Group A (well-controlled diabetes) and Group B (poorly controlled diabetes). ALT levels were measured, with values >40 IU/L considered elevated. Data were analyzed using SPSS version 24. Independent t-tests were applied to compare mean ALT levels between the two groups, with a p-value ≤ 0.05 considered statistically significant. Results: The mean age in Group A was 48.94 ± 12.70 years, while Group B was 47.61 ± 12.19 years. Group A had significantly lower mean ALT levels (17.78 ± 11.09 IU/L) compared to Group B (27.43 ± 13.57 IU/L), with the difference being statistically significant (p = 0.0001). Conclusion: Well-controlled type 2 diabetic patients with NAFLD exhibited significantly lower ALT levels compared to those with poorly controlled diabetes. These findings underscore the importance of maintaining optimal glycemic control to mitigate hepatic injury in diabetic patients with NAFLD.

SAFETY AND EFFICACY OF CONCURRENT RADIOTHERAPY AND CETUXIMAB CHEMOTHERAPY VS RADIOTHERAPY ALONE FOR AGGRESSIVE SQUAMOUS CELL SKIN CANCER OF THE HEAD AND NECK

A BASHIR — 2025-05-30

Background: Aggressive squamous cell carcinoma (SCC) of the head and neck presents a therapeutic challenge due to its high recurrence and progression rates. While radiotherapy is a standard postoperative treatment, the addition of concurrent chemotherapy may enhance outcomes by improving locoregional control and overall survival. Cetuximab, an epidermal growth factor receptor (EGFR) inhibitor, has demonstrated efficacy in enhancing the therapeutic response in head and neck cancers. Objective: To compare the efficacy and safety of concurrent radiotherapy and cetuximab chemotherapy with radiotherapy alone in the treatment of aggressive squamous cell carcinoma of the head and neck. Study Design: Retrospective comparative study. Setting: Oncology Department, Nishtar Hospital, Multan, Pakistan. Duration of Study: February 2023 to February 2025. Methods: A total of 200 adult patients with histologically confirmed aggressive head and neck squamous cell carcinoma who underwent surgical resection were included through consecutive sampling. Patients were divided into two groups: Group A (n=100) received concurrent radiotherapy (average dose: 60 Gy in 2–2.25 Gy fractions) and cetuximab chemotherapy (400 mg/m² initial dose followed by 250 mg/m² weekly), and Group B (n=100) received radiotherapy alone. Key outcomes included local and metastatic recurrence rates, progression-free survival (PFS), overall survival (OS), and treatment-related adverse events. Statistical analysis was performed using chi-square and t-tests, with p < 0.05 considered statistically significant. Results: Local Non-Recurrence Rates: 1-year: 92% (Group A) vs. 94% (Group B); 2-year: 84% vs. 75%. Metastatic Non-Recurrence Rates: 1-year: 98% vs. 100%; 2-year: 94% vs. 89%. Progression-Free Survival: 1-year: 85% vs. 76%; 2-year: 73% vs. 55%. Overall Survival: 1-year: 99% (Group A) vs. 80% (Group B); 2-year: 79% vs. 74%. Adverse Events: Grade 3 dermatitis occurred in 15% of Group A and 30% of Group B patients. Conclusion: Concurrent radiotherapy with cetuximab chemotherapy demonstrated improved 2-year progression-free and overall survival in patients with aggressive head and neck squamous cell carcinoma compared to radiotherapy alone, with an acceptable safety profile. These findings support the use of combined modality treatment for better clinical outcomes.

COMPLICATIONS OF SNODGRASS URETHROPLASTY IN PATIENTS WITH DISTAL AND MID PENILE HYPOSPADIAS

M AAMIR — 2025-04-16

Background: Hypospadias is a common congenital anomaly in males, with surgical correction being the primary treatment. The Snodgrass urethroplasty, or tubularized incised plate (TIP) urethroplasty, is widely used for distal and mid-penile hypospadias repair. However, postoperative complications such as urethrocutaneous fistula and meatal stenosis remain clinical concerns. Objective: To assess the postoperative complications of Snodgrass urethroplasty in pediatric patients with distal and mid-penile hypospadias. Study Design: Descriptive cross-sectional study. Setting: Conducted at Hayatabad Medical Complex, Peshawar, a tertiary care plastic surgery unit. Duration of Study: 04-07-2024 to 04-01-2025. Methods: A total of 80 male patients, aged 1–10 years, diagnosed with distal or mid-penile hypospadias through physical examination, were enrolled. All patients underwent Snodgrass urethroplasty. Postoperative complications, specifically urethrocutaneous fistula and meatal stenosis, were assessed on the 30th postoperative day. Data were analyzed using SPSS version 22.0, and frequencies and percentages were calculated. Results: The mean age of the cohort was 5.79 ± 2.68 years. Distal hypospadias accounted for 87.5% of cases, while mid-penile hypospadias comprised 12.5%. Urethrocutaneous fistula was observed in 12.5% of patients, and meatal stenosis occurred in 6.25%. Complications were more frequently noted among patients with mid-penile hypospadias compared to those with distal variants. Conclusion: Snodgrass urethroplasty is an effective technique for correcting distal and mid-penile hypospadias, with acceptable complication rates. Urethrocutaneous fistula (12.5%) and meatal stenosis (6.25%) were the most common postoperative issues, particularly in patients with mid-penile hypospadias. Early identification and management of these complications are essential to improving surgical outcomes.

COMPARISON OF OUTCOME AFTER OCCLUSIVE HYDROCOLLOID DRESSING AND PETROLEUM-IMPREGNATED GAUZE WITH ZINC OXIDE ADHESIVE PLASTER FOLLOWING HYPOSPADIAS REPAIR

T SHAH — 2025-05-29

Background: Postoperative dressing plays a vital role in the healing process following hypospadias repair. An ideal dressing should minimize complications such as wound dehiscence, meatal stenosis, and urethrocutaneous fistula. However, the optimal dressing method remains a matter of debate. Objective: To compare the postoperative outcomes between occlusive hydrocolloid dressing and petroleum-impregnated gauze with zinc oxide adhesive plaster in children undergoing primary hypospadias repair. Study Design: Prospective non-randomized controlled trial. Setting: Department of Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar, Pakistan. Duration of Study: 03-February-2025 to 03-May-2025. Methods: A total of 158 pediatric patients aged 1–14 years undergoing primary hypospadias repair were enrolled in this study. Participants were randomly assigned to two groups. Group A (n = 79) received an occlusive hydrocolloid dressing, and Group B (n = 79) received petroleum-impregnated gauze with zinc oxide adhesive plaster. A standardized surgical technique was followed for all patients, and dressings were removed on postoperative day 3. Postoperative complications including urethrocutaneous fistula, meatal stenosis, and wound dehiscence were recorded. Statistical analysis was performed using the chi-square test, with a p-value of less than 0.05 considered statistically significant. Results: Urethrocutaneous fistula occurred in 10.1% of patients in Group A and 8.9% in Group B (p = 0.78). Meatal stenosis was observed in 2.5% of patients in Group A and 1.3% in Group B (p = 0.56). Wound dehiscence was reported in 3.8% of Group A and 2.5% of Group B patients (p = 0.64). No statistically significant differences were found between the two groups for any of the assessed outcomes. Conclusion: Both occlusive hydrocolloid dressing and petroleum-impregnated gauze with zinc oxide plaster demonstrated comparable outcomes in terms of urethrocutaneous fistula, meatal stenosis, and wound dehiscence following primary hypospadias repair. Either dressing modality may be considered based on clinical preference, cost, and availability.

HOSPITAL-ACQUIRED COMPLICATIONS OF ANEURYSMAL SUBARACHNOID HEMORRHAGE

M KHAN — 2025-04-24

Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening neurological emergency with high rates of morbidity and mortality. Despite advancements in diagnostic and therapeutic strategies, hospital-acquired complications remain a significant contributor to adverse outcomes in aSAH patients. Understanding the frequency and pattern of these complications is essential for improving patient care and outcomes. Objective: To assess the frequency of hospital-acquired complications in patients with aSAH and to compare the findings with existing literature to identify areas for potential improvement in patient management. Study Design: Descriptive observational study. Setting: Neurology Department, Fouji Foundation Hospital, Rawalpindi, Pakistan. Duration of Study: The study was conducted from 11-09-2024 to 11-03-2025. Methods: A total of 107 patients aged 18 to 75 years with confirmed aneurysmal subarachnoid hemorrhage were included. The diagnosis was based on clinical presentation and neuroimaging. Data collected included patient demographics, aneurysm characteristics, and the incidence of hospital-acquired complications. Complications observed included hydrocephalus, mechanical ventilation requirement, symptomatic vasospasm, and delayed cerebral ischemia (DCI). Descriptive statistics were applied using SPSS software to analyze the data. Results: The mean age of patients was 46.29 ± 16.86 years, with females comprising 53.3% of the cohort. The most common hospital-acquired complications were hydrocephalus (51.4%), need for mechanical ventilation (42.1%), symptomatic vasospasm (34.6%), and delayed cerebral ischemia (DCI) (20.6%). Conclusion: Hospital-acquired complications are prevalent among patients with aSAH, particularly hydrocephalus, symptomatic vasospasm, and DCI, which significantly influence clinical outcomes. These findings emphasize the need for early identification and proactive management of complications to improve prognosis and reduce morbidity in aSAH patients. Further studies with a larger sample size and multicenter data are recommended for broader applicability.

INTRACAVERNOUS PLATELET LYSATE INJECTIONS FOR ERECTILE DYSFUNCTION IN DIABETIC MEN: A STUDY ON CLINICAL OUTCOMES AND EFFICACY

Z MAJEED — 2025-04-16

Background: Erectile dysfunction (ED) is a prevalent complication among diabetic men, often refractory to conventional pharmacologic therapies due to vascular and neural impairments. Platelet lysate (PL), a growth factor-rich biological derivative, has emerged as a potential regenerative therapy for vasculogenic ED. However, data on its clinical efficacy and safety remain limited, particularly in resource-constrained settings. Objective: To evaluate the efficacy and safety of intracavernous PL injections in diabetic men with moderate to severe ED. Study Design: Prospective interventional study. Setting: The study was conducted at the Institute of Kidney Diseases, Peshawar, Pakistan. Duration of Study: February 18, 2024, to February 18, 2025. Methods: A total of 72 diabetic men aged 40–65 years with moderate to severe ED (International Index of Erectile Function-5 [IIEF-5] score: 5–11) were enrolled. Each participant received three intracavernous injections of autologous PL at two-week intervals. Erectile function was assessed using the IIEF-5 questionnaire at baseline and 12 weeks post-treatment. Adverse events were monitored to evaluate treatment safety. Statistical analysis was performed using SPSS v26, with a p-value of <0.05 considered statistically significant. Results: The mean IIEF-5 score significantly improved from 8.6 ± 1.9 at baseline to 15.3 ± 2.8 at 12 weeks (p < 0.001). Improvements were observed in all erectile function domains, including erection confidence, penetration ability, and overall satisfaction. Clinically significant improvement was noted in 86.8% of patients with moderate ED and 73.5% of those with severe ED. The treatment was well tolerated, with mild, transient adverse effects, including penile pain (12.5%) and local bruising (8.3%). No cases of fibrosis, priapism, or infection were reported. Conclusion: Intracavernous PL injections demonstrated significant efficacy and safety in diabetic men with ED, leading to substantial improvements in erectile function and patient satisfaction. These findings highlight PL therapy as a promising alternative for ED management, particularly in patients unresponsive to conventional treatments and in resource-limited healthcare settings. Further large-scale studies are recommended to validate these results.

RISK FACTORS OF ACUTE KIDNEY INJURY PATIENTS PRESENTING TO TERTIARY CARE HOSPITAL

A KHAN — 2025-06-20

Background: Acute kidney injury (AKI) is a common and serious clinical condition with significant morbidity and mortality. Identifying precipitating risk factors is essential for early diagnosis and effective management. In developing countries, limited hospital data are available regarding the etiology and comorbidities associated with AKI. Objective: To evaluate the risk factors contributing to acute kidney injury (AKI) in patients admitted to a tertiary care hospital. Study Design: Descriptive cross-sectional study. Setting: Department of Medicine, Saidu Group of Teaching Hospital, Swat, Pakistan. Duration of Study: Six months (29-07-2023 to 29-01-2024). Methods: A total of 156 patients aged 18 to 80 years presenting with AKI were included using consecutive non-probability sampling. AKI was defined based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria as an increase in serum creatinine ≥0.3 mg/dL within 48 hours, a 1.5-fold increase from baseline within 7 days, or urine output <0.5 mL/kg/hour for 6 hours. Risk factors evaluated included sepsis, cardiovascular events, and diarrhea. Data were analyzed using SPSS version 26. Chi-square test was applied to assess associations with comorbid conditions, with a p-value ≤ 0.05 considered statistically significant. Results: The mean age was 51.2 ± 17.1 years, and 56.4% were male. Sepsis was identified in 41.0% of patients, followed by cardiovascular events in 17.3%, and diarrhea in 14.1%. Sepsis was more frequent in older adults (>60 years: 43.8%). Cardiovascular-related AKI was significantly associated with diabetes (70.4%, p = 0.0001) and hypertension (81.5%, p = 0.009). Conclusion: Sepsis, cardiovascular events, and diarrhea are leading risk factors for AKI in hospitalized patients. Advanced age, hypertension, and diabetes are strongly associated with these triggers. Early recognition and targeted management strategies are crucial to reduce AKI-related complications and improve patient outcomes.

COMPARISON OF 550MG/DAY VERSES 1100 MG/DAY RIFAXIMIN IN SECONDARY PREVENTION OF BOTH COVERT AND OVERT HEPATIC ENCEPHALOPATHY

N BIBI — 2025-05-15

Hepatic encephalopathy (HE) is a serious complication of liver cirrhosis, presenting in covert and overt forms, and often recurs after initial treatment. Rifaximin, a non-absorbable antibiotic, is widely used for secondary prevention, but the optimal dose for preventing HE recurrence remains uncertain. Objective: To compare the frequency of recurrence of both covert and overt hepatic encephalopathy in patient taking rifaximin at 550mg/day verses 1100mg/day. Study Design: Randomized, controlled, comparative study. Setting: Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan. Duration of Study: Six months, from September 6, 2024, to March 6, 2025. Methods: A total of 160 patients diagnosed with either covert or overt HE were enrolled and randomized into two treatment groups via block randomization. Group A received 550 mg/day rifaximin, and Group B received 1100 mg/day. The primary outcome was the frequency of HE recurrence over the study period. Statistical analysis was performed using SPSS version 26. Chi-square test was applied to compare recurrence rates between groups, with p < 0.05 considered statistically significant. Results: In Group A, 47.5% of patients experienced recurrence of HE, compared to 43.8% in Group B. The difference in recurrence rates between the two groups was not statistically significant (p = 0.63). Conclusion: There was no significant difference in the efficacy of 550 mg/day versus 1100 mg/day rifaximin in preventing HE recurrence. Given the comparable outcomes, the standard 550 mg/day dose remains the preferred regimen for secondary prevention of hepatic encephalopathy due to its effectiveness and potential cost-benefit advantage.

USE OF G10 SCORING SYSTEM TO PREDICT DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY AND CONVERSION TO OPEN CHOLECYSTECTOMY

SF SUBHAN — 2025-04-04

Background: Laparoscopic cholecystectomy (LC) is the gold standard for treating gallbladder disease; however, some cases present technical challenges that necessitate conversion to open cholecystectomy (OC). Identifying factors associated with difficult LC and conversion to OC can help optimize surgical planning and patient counseling. Objective: To evaluate the frequency of difficult laparoscopic cholecystectomies and the rate of conversion to open cholecystectomies in patients undergoing laparoscopic cholecystectomy (LC). Study Design: Observational cross-sectional study. Setting: The study was conducted at Saidu Teaching Hospital in Swat. Duration of Study: The study was conducted over six months, from August 16, 2024, to February 16, 2025. Methods: A total of 126 patients undergoing laparoscopic cholecystectomy (gallbladder surgery) were included. Surgical difficulty was assessed using the G10 scoring system, which evaluates factors such as inflammation, adhesions, and anatomical variations. Conversion rates from LC to OC were recorded. Demographic characteristics, surgical difficulty, and outcome variables were analyzed using SPSS version 20. The statistical significance of the predictive factors was assessed, with p-values of less than 0.05 considered significant. Results: Difficult labor was observed in 14 patients (11.1%), while conversion to cesarean section was required in 8 cases (6.3%). Age and gender were significant predictors of difficult LC and conversion to OC. Patients with a higher BMI (>24.9 kg/m²) had an increased likelihood of complex surgery and conversion; however, the association was not statistically significant. Conclusion: The frequency of difficult laparoscopic cholecystectomy was 11.1%, and the conversion rate to open surgery was 6.3%. Age and gender were notable predictive factors for surgical difficulty and conversion. Preoperative risk assessment using scoring systems, such as G10, can aid in surgical decision-making and improve patient outcomes.

COMPARISON OF CLINICAL MANIFESTATION AND RISK FACTORS OF STROKE AMONG DIABETIC VS NON-DIABETIC PATIENTS

M ILYAS — 2025-06-12

Background: Stroke is a leading cause of morbidity and mortality worldwide. Diabetes mellitus is a known risk factor that may influence both the presentation and progression of stroke. Understanding the differences in clinical manifestations and risk factors between diabetic and non-diabetic stroke patients is essential for tailored prevention and management strategies. Objective: To compare the clinical manifestations and associated risk factors of stroke among diabetic and non-diabetic patients. Study Design: Cross-sectional study. Setting: The study was conducted at the department of Medicine, Saidu Group of Teaching Hospital Swat, Pakistan]. Duration of Study: August 2024 to January 2025. Methods: The study included 80 patients aged 40 years and above who were diagnosed with stroke, confirmed by clinical examination and neuroimaging. Patients were categorized into two equal groups: diabetics (n = 40) and non-diabetics (n = 40). Data were collected on demographics, risk factors (hypertension, dyslipidemia, smoking, atrial fibrillation, and previous stroke history), and clinical manifestations (motor deficits, aphasia, dysarthria, and altered sensorium). Statistical analysis was conducted using Chi-square tests and independent t-tests, with a p-value <0.05 considered statistically significant. Results: The mean age of diabetic patients was 50.65 ± 7.49 years, while that of non-diabetics was 52.20 ± 6.09 years. Motor deficits were observed in 80% of diabetics and 75% of non-diabetics (p > 0.05). Dysarthria occurred in 55% vs 45% (p > 0.05), aphasia in 22.5% vs 25% (p > 0.05), and altered sensorium in 45% vs 32.5% (p > 0.05), respectively. Hypertension was significantly more prevalent in diabetics (62.5%) compared to non-diabetics (30%) (p = 0.004). Dyslipidemia was more common in diabetics (60%) than in non-diabetics (42.5%) (p > 0.05). Atrial fibrillation and previous stroke history did not differ significantly between groups. Conclusion: While clinical manifestations of stroke were similar between diabetic and non-diabetic patients, hypertension was significantly more prevalent in the diabetic group. These findings highlight the importance of strict blood pressure control in diabetic patients to prevent stroke-related complications.

COMPARATIVE STUDY OF EXTERNAL FIXATOR AND INTRAMEDULLARY NAILING IN PATIENTS WITH GUSTILO TIBIO FIBULAR FRACTURE TYPE III A: A RANDOMIZED CONTROLLED TRIAL

H ALI — 2025-05-05

Background: Gustilo type IIIA tibiofibular fractures present a significant challenge in orthopedic trauma due to extensive soft tissue damage and high risk of complications such as infection, malunion, and non-union. Optimal fixation strategy remains debated, particularly in severe open fractures. Objective: To assess and compare the clinical outcomes of intramedullary nailing (IMN) versus external fixation (EF) in the management of Gustilo type IIIA tibiofibular fractures. Study Design: Prospective randomized controlled trial. Setting: Conducted at Khyber Teaching Hospital, Peshawar, Pakistan. Duration of Study: January 2024 to June 2024. Methods: A total of 140 patients aged 18–65 years with confirmed Gustilo type IIIA tibiofibular fractures were enrolled and randomized into two equal groups: IMN group (n=70) and EF group (n=70). All procedures were performed under standardized surgical protocols. The primary clinical outcomes assessed included fracture union, malunion, non-union, infection, and need for reoperation. Follow-up assessments were conducted for at least 12 months postoperatively. Statistical analysis was performed using SPSS version 26. Chi-square test was used for categorical variables and p-values < 0.05 were considered statistically significant. Results: The IMN group showed superior clinical outcomes to the EF group. Successful union was achieved in 91.4% of IMN patients versus 78.6% in the EF group (p=0.03). Malunion rates were lower in the IMN group (4.3% vs. 14.3%, p=0.04), as were non-union (5.7% vs. 17.1%, p=0.03), reoperation (7.1% vs. 18.6%, p=0.04), and infection rates (4.3% vs. 18.6%, p=0.008). Conclusion: Intramedullary nailing demonstrated significantly better outcomes than external fixation in managing Gustilo type IIIA tibiofibular fractures, with higher union rates, fewer infections, and reduced need for reoperation. IMN should be considered a preferable option for this fracture type in appropriately selected patients.

PRACTICES AND OUTCOMES OF NEONATAL RESUSCITATION FOR NEWBORNS WITH BIRTH ASPHYXIA IN TERTIARY CARE HOSPITALS IN LAHORE, PAKISTAN

S NASIM — 2025-03-20

Background:Neonatal resuscitation (NR) is a critical intervention to reduce neonatal morbidity and mortality associated with birth asphyxia. The effectiveness of NR practices by healthcare professionals (HCPs) significantly influences newborn outcomes. However, gaps in NR training and adherence to standardized resuscitation protocols may impact survival and long-term health. Evaluating NR practices and their association with neonatal outcomes can help identify areas for improvement and optimize neonatal care. Objective: To observe the NR practices of HCPs and their outcomes and to determine the associations between practices and outcomes. Study Design: Observational Cross-sectional study. Setting: The study was conducted in the neonatal resuscitation unit of a tertiary care hospital. Duration of Study: March 2024 to August 2024. Methods: One thousand six hundred and forty neonates were followed, and out of them, a total of 138 newborn resuscitations were observed by 46 HCPs using a predetermined adopted checklist. Newborns with birth asphyxia by the WHO criteria, as well as criteria defined by the American Academy of Pediatrics, were included in the study. The complete bio-data of health care professionals was documented with their way of resuscitation. The observer was present in the resuscitation area every time a delivery was being conducted. Data was analyzed using the SPSS software. The chi-square test was used to determine the association between NR practices and outcomes at one hour. Result: 45.7% of the HCPs were within the age group of 26-30 years, with 55.2% as females. The majority of them are doctors, followed by nurses. 50.7% HCPs prepared the area for resuscitation, and only 18.8% identified a helper. 95.7% dried the baby, and 76.8% removed the wet cloth. 96.4% HCPs cleared the baby's airway. Meconium was present in 42% of neonates. Only 27.9% HCPs started BMV within the Golden minute (60s), 75% used the correct mask size and 96.9% observed chest movement. According to the level of practices by HCPs, good scores were as follows: 74.6% in Drying/Stimulating, 89.7% for Support Ventilation, 39.9% in Open Airway, 27.9 % for BMV, and in ABMW, 44.8% of HCPs demonstrated good practices. 16.7% neonates recovered well, 47.1% needed oxygen therapy, 29% required intensive care, and 7.2% died after 01 hour. Suctioning before the baby breathes (p-value .001), placing the baby's head in a neutral position (p-value = .013), initiation of BMV (p-value <.05), and checking the baby's heart rate after 1 minute (p-value = .022) were associated with newborn outcomes at 1 hour. Conclusion: The Majority of the HCPs were inadequately trained for NR practices. However, a significant association among HCPs' NR practices (airway management and advanced resuscitation practices) and outcomes was observed. Structured and ongoing NR training for HCPs can improve practices and contribute to reduced newborn morbidity and mortality rates. Consequently, it will be helpful for lowering healthcare costs for families and the healthcare system and will contribute to the national economy..

MATERNAL AND FETAL OUTCOMES IN PREGNANCIES COMPLICATED BY PLACENTA PREVIA

SH KHEL — 2025-06-10

Background: Placenta previa is a significant obstetric complication associated with increased maternal and neonatal morbidity. It often leads to adverse outcomes such as postpartum hemorrhage, cesarean delivery, and preterm birth, necessitating timely diagnosis and multidisciplinary management. Objective: To evaluate maternal and fetal outcomes in pregnancies complicated by placenta previa. Study Design: Cross-sectional study. Setting: The department of Obs and Gynae of Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: 02-10-2024 to 02-04-2025. Methods: A total of 139 pregnant women aged 18–35 years with singleton pregnancies beyond 28 weeks of gestation were included. Placenta previa was diagnosed via ultrasound. Maternal outcomes assessed included mode of delivery, postpartum hemorrhage (PPH), anemia, and ICU admission. Neonatal outcomes evaluated were preterm birth, low birth weight (LBW), Apgar scores at 5 minutes, and NICU admissions. Data were analyzed using descriptive statistics; results are presented as frequencies, percentages, and means with standard deviations. Results: The mean maternal age was 28.24 ± 4.89 years. Cesarean section was the mode of delivery in 74.1% of cases. Postpartum hemorrhage occurred in 22.3% of patients, and anemia was documented in the same proportion. ICU admission was required in 15.8% of cases. Among neonates, the preterm birth rate was 51.8%, with 30.9% having low birth weight. NICU admission was needed for 23.0% of newborns, and 14.4% had low Apgar scores (<7) at 5 minutes. Conclusion: Pregnancies complicated by placenta previa are associated with a high risk of adverse maternal and neonatal outcomes, including postpartum hemorrhage, cesarean delivery, preterm birth, and NICU admissions. Early identification and multidisciplinary care are essential to optimize outcomes for both mother and child.

BLOOD CULTURE PROVEN COMMON BACTERIAL PATHOGENS IN PATIENTS ADMITTED IN THE PEDIATRIC UNIT OF A TERTIARY CARE HOSPITAL IN PAKISTAN

MI KHAN — 2025-05-12

Background: Bloodstream infections (BSIs) in pediatric populations represent a substantial burden of morbidity and mortality, particularly in developing countries. Rapid identification of causative bacterial pathogens and determination of their antimicrobial susceptibility profiles are essential for timely intervention and effective management of sepsis. Objective: To determine the spectrum of bacterial pathogens isolated from blood cultures and assess their antimicrobial sensitivity patterns among pediatric patients admitted with sepsis at a tertiary care hospital in Pakistan. Study Design: Descriptive cross-sectional study. Settings: Department of Pediatrics, Fauji Foundation Hospital, Rawalpindi, Pakistan. Duration of Study: 23 January 2025 to 23 April 2025. Methods: Blood samples were collected aseptically from pediatric patients meeting the clinical criteria for sepsis and processed using an automated BACTEC system. Standard microbiological techniques, identified bacterial isolates, and antimicrobial susceptibility testing were conducted by Clinical and Laboratory Standards Institute (CLSI) guidelines. Data were analyzed using SPSS version 25.0, with Chi-square tests applied to evaluate associations between categorical variables. Results: Among 145 enrolled patients, 117 (80.7%) demonstrated positive blood cultures. Staphylococcus aureus was the predominant pathogen (27.4%), followed by Escherichia coli (23.9%) and Klebsiella pneumoniae (22.2%). Staphylococcus aureus exhibited 100% sensitivity to vancomycin, while imipenem showed high efficacy against E. coli (95%) and K. pneumoniae (90%). Notably, substantial resistance to third-generation cephalosporins was observed. A statistically significant association was found between male gender and a higher incidence of Staphylococcus aureus infections (p=0.045). Conclusion: Staphylococcus aureus remains the leading cause of pediatric bloodstream infections, and emerging antimicrobial resistance patterns pose a serious challenge to empirical therapy. Routine surveillance of bacterial pathogens and their resistance profiles is imperative to guide effective antimicrobial stewardship and improve clinical outcomes in Pakistan's pediatric population.

ROLE OF MANNITOL IN IMPROVING THE OUTCOMES OF MODERATE TO SEVERE PERINATAL ASPHYXIA

M MATEEN — 2025-03-20

Background: Birth asphyxia, defined as inadequate oxygen supply to a newborn during delivery, is a major cause of neonatal morbidity and mortality, second only to sepsis. While its incidence in developed countries ranges from 1% to 1.5% of live births, it rises significantly in developing nations, reaching up to 5%. Effective management of moderate to severe birth asphyxia remains a challenge. This study evaluates the efficacy of Mannitol infusion in improving survival outcomes in neonates diagnosed with moderate to severe perinatal asphyxia. Objective: To assess the effectiveness of Mannitol in managing cases of moderate to severe perinatal asphyxia in full-term neonates. Study Design: Case series study. Setting: Department of Pediatrics Medicine, Sughra Shafi Medical Complex, Narowal. Duration of Study: March 2, 2023, to September 1, 2023. Methods: A total of 141 full-term neonates diagnosed with moderate to severe perinatal asphyxia were included using consecutive non-probability sampling. Mannitol 20% was administered intravenously at a dosage of 1.5 mL/kg over 20 minutes every 8 hours. All neonates received standard supportive treatment according to established neonatal care protocols. The primary outcome measure was survival or mortality. Data were analyzed using SPSS version 25.0, and post-stratification analysis was conducted using the Chi-square test, with statistical significance set at p ≤ 0.05. Results: Among the 141 neonates, 91 (64.5%) were males and 50 (35.5%) were females. The mean age was 16.35 ± 6.534 days. Mannitol therapy resulted in a survival rate of 82.3% (116 neonates), while mortality was observed in 17.7% (25 neonates). Conclusion: Mannitol infusion demonstrated promising effectiveness in the management of moderate to severe perinatal asphyxia, significantly improving survival rates. These findings support the potential role of Mannitol as a therapeutic option in neonatal intensive care settings, warranting further large-scale studies to validate its efficacy and safety.

MINIMALLY INVASIVE OVER THE TOP DECOMPRESSION IN MULTILEVEL LUMBAR STENOSIS: CLINICAL RESULTS

ZU REHMAN — 2025-06-10

Background: Multilevel lumbar spinal stenosis (LSS) is a common degenerative spinal condition in the elderly population, often leading to significant disability and reduced quality of life. Traditional open surgeries can be associated with higher morbidity, prompting the shift towards minimally invasive techniques such as “over-the-top” decompression, which preserves spinal stability while achieving effective neural decompression. Objective: To evaluate the clinical outcomes of minimally invasive over-the-top decompression in patients with multilevel lumbar spinal stenosis. Study Design: Cross-sectional study. Setting: Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: Three years, from January 2021 to December 2023. Methods: A total of 320 patients aged 50 years or older with MRI-confirmed multilevel lumbar spinal stenosis were included. All patients underwent minimally invasive over-the-top decompression under general anesthesia. The primary outcome was the change in Oswestry Disability Index (ODI) scores. Secondary outcomes included changes in pain scores using the Visual Analog Scale (VAS), walking distance, analgesic consumption, and postoperative complications. Data were analyzed using SPSS version 25.0. Paired t-tests were employed to compare preoperative and postoperative values, with a significance level set at p < 0.05. Results: The mean age of the cohort was 65.6 ± 7.8 years, with 53.4% male and 46.6% female patients. ODI scores significantly improved from a preoperative mean of 42.6 ± 10.4 to 22.4 ± 8.6 postoperatively (p < 0.001). VAS pain scores decreased from 7.9 ± 1.2 to 3.2 ± 1.4 (p < 0.001). Walking distance increased from 100.6 ± 20.4 meters to 300.8 ± 50.6 meters postoperatively. There was also a marked reduction in analgesic usage. The complication rate was low and within acceptable limits. Conclusion: Minimally invasive over-the-top decompression for multilevel lumbar spinal stenosis offers significant clinical improvement in terms of pain relief, functional disability, and walking capacity, with a favorable safety profile and reduced postoperative morbidity.

FREQUENCY OF BLOOD EOSINOPHILIA IN PATIENTS WITH NEWLY DIAGNOSED CHRONIC OBSTRUCTIVE PULMONARY DISEASE

M SHOAIB — 2025-04-30

Background: Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality worldwide. Blood eosinophilia is a potential biomarker for disease phenotyping and therapeutic guidance in COPD management. However, limited data exist on the prevalence of eosinophilia among newly diagnosed COPD patients in regional settings. Objective: To evaluate the frequency of blood eosinophilia in patients newly diagnosed with COPD. Study Design: Cross-sectional study. Setting: Department of Pulmonology at Saidu Group of Teaching Hospital, Swat. Duration of Study: 26-09-2024 to 26-12-2024. Methods: A total of 144 patients aged 30–80 years with newly diagnosed COPD (post-bronchodilator FEV₁/FVC ratio <0.70) were included. Patients with comorbid asthma, bronchiectasis, or active tuberculosis were excluded. Blood eosinophilia was defined as an absolute eosinophil count >500 cells/µL. Demographic details and comorbid conditions were recorded. Data were analyzed using SPSS version 24. Chi-square and independent t-tests were applied, with p-values ≤ 0.05 considered statistically significant. Results: The mean age of participants was 58.3 ± 10.5 years, with a male predominance (61.8%). Blood eosinophilia was observed in 52 (36.1%) patients. Hypertension and diabetes mellitus were present in 53.5% and 45.1% of patients, respectively. No statistically significant associations were found between eosinophilia and demographic or comorbidity profiles (p > 0.05). Conclusion: Blood eosinophilia was present in approximately one-third (36.1%) of patients with newly diagnosed COPD. These findings support the relevance of eosinophil count in the initial assessment of COPD, potentially aiding in future phenotypic classification and individualized treatment strategies.

FREQUENCY OF PATTERN OF ADMISSIONS IN PATIENTS WITH DECOMPENSATED LIVER DISEASE

. YASIR — 2025-03-18

Background: Decompensated liver disease is a critical stage of chronic liver disease, characterized by complications such as ascites, variceal bleeding, and hepatic encephalopathy. Understanding these patients' admission patterns can help optimize management strategies and improve clinical outcomes. Objective: To determine the frequency of admission patterns in patients with decompensated liver disease. Study Design: Cross-sectional study. Setting: Hospital-based study. Duration of Study: August 11, 2024 – February 11, 2025. Methods: A total of 143 patients diagnosed with decompensated liver disease were enrolled using consecutive non-probability sampling. The diagnosis was confirmed based on ultrasound findings of irregular liver margins, altered parenchymal echogenicity, and serum albumin levels <3.5 g/dL. Patients aged 18–70 years were included, while those with chronic kidney disease, diabetes, hypertension, or pregnancy/lactation were excluded. Clinical assessments were conducted under the supervision of an experienced consultant. Ascites were identified through CT imaging and symptoms of abdominal distension, variceal bleeding via endoscopic confirmation, and hepatic encephalopathy based on clinical signs such as asterixis and altered mental status. Data on demographics and admission patterns were collected using a structured proforma and analyzed using SPSS version 25. Results: Ascites were the most common reason for hospital admission, affecting 45.5% of patients, followed by variceal bleeding (14%) and hepatic encephalopathy (7.7%). The mean age of participants was 44.5 years, with a male-to-female ratio of 54.5% to 45.5%. Most patients belonged to middle-income socioeconomic backgrounds (55.2%), and 59.4% were uneducated. Urban residents constituted 56.6% of the cohort, while 43.4% were from rural areas. Conclusion: The study highlights ascites as the predominant reason for hospitalization among patients with decompensated liver disease, followed by variceal bleeding and hepatic encephalopathy. These findings emphasize the need for early intervention strategies, improved outpatient management, and targeted healthcare policies to reduce hospital admissions and improve patient outcomes.

IMPACT OF NOMOPHOBIC BEHAVIOR ON NURSES' CARE BEHAVIORS WORKING IN INTENSIVE CARE UNIT IN TERTIARY CARE HOSPITALS, LAHORE, PAKISTAN

A ZUNIRA — 2025-06-15

Background: Nomophobia, defined as the fear or anxiety stemming from being without a mobile phone, has emerged as a behavioral phenomenon in the digital age. In critical care environments such as intensive care units (ICUs), excessive smartphone use among nurses may adversely impact focus, empathy, and the overall quality of patient care. Objective: To determine the prevalence of nomophobic behavior and its impact on the caring behaviors of ICU nurses in tertiary care hospitals in Lahore, Pakistan. Study Design: Descriptive cross-sectional study. Settings:
Punjab Institute of Cardiology and Sir Ganga Ram Hospital, Lahore, Pakistan. Duration of Study: From 14 July 2022 to 31 July 2024. Methods: A total of 222 ICU nurses were selected via simple random sampling. Data collection tools included a validated self-administered questionnaire comprising demographic data, the Nomophobia Questionnaire (NMP-Q), and the Caring Behavior Inventory (CBI). Data were analyzed using SPSS version 25. Descriptive statistics were used to summarize the data, and Pearson’s correlation coefficient was applied to evaluate the relationship between nomophobia and caring behavior. Results: Among the participants, 93.7% demonstrated high levels of nomophobia, while 45.5% exhibited poor caring behaviors. A significant inverse correlation was observed between nomophobia and caring behavior (r² = 0.49, p < 0.001), suggesting that increased nomophobic tendencies were associated with decreased caring behavior among ICU nurses. Conclusion: Nomophobia is highly prevalent among ICU nurses and is inversely associated with their professional caring behaviors. Institutional strategies—including digital professionalism training, policy reform, and awareness initiatives—are essential to curb the negative impact of smartphone dependency on critical patient care.

PATTERN OF STROKE IN PATIENTS WITH DIABETES MELLITUS PRESENTING TO TERTIARY CARE HOSPITAL

A KHAN — 2025-04-24

Background: Stroke remains a leading cause of morbidity and mortality globally, with diabetes mellitus being a significant risk factor. Diabetic patients are predisposed to both ischemic and hemorrhagic stroke due to vascular complications. Understanding the stroke pattern in diabetic individuals is crucial for targeted prevention and management strategies. Objective: To assess the pattern of stroke—ischemic or hemorrhagic-in diabetic patients presenting to a tertiary care hospital. Study Design: Descriptive cross-sectional study. Setting: Department of Medicine, Saidu Teaching Hospital, Swat. Duration of Study: The study spanned a defined period (29-July-2023 to 29 January 2024). Methods: A total of 100 diabetic patients presenting with stroke were enrolled. Demographic data, including age, gender, and history of hypertension, were collected. Stroke type was confirmed using neuroimaging techniques such as CT or MRI. Statistical analysis was performed using SPSS version 24, with chi-square tests applied to assess the association between patient characteristics and stroke type. A p-value ≤ 0.05 was considered statistically significant. Results: The mean age of participants was 51.65 ± 13.56 years. A male predominance was noted (61%). Hypertension was present in 61% of patients. Ischemic stroke was more prevalent (87%) compared to hemorrhagic stroke (13%). A statistically significant association was found between increasing age and the type of stroke (p = 0.02). Conclusion: Ischemic stroke is significantly more common than hemorrhagic stroke among diabetic patients, accounting for 87% of cases. Age appears to be an essential factor influencing stroke type. These findings underscore the need for proactive screening and prevention of ischemic events in diabetic populations.

ROLE OF BUBBLE CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) IN RESPIRATORY DISTRESS IN PRETERM NEONATES

M AFTAB — 2025-01-30

Background: Respiratory distress syndrome (RDS) is a leading cause of neonatal morbidity and mortality, particularly in preterm infants. Non-invasive ventilation strategies, such as bubble continuous positive airway pressure (bCPAP), have been shown to reduce the need for mechanical ventilation and improve pulmonary outcomes by preventing alveolar collapse and enhancing functional residual capacity. However, the efficacy and success rates of bCPAP in neonates with RDS require further evaluation. Objective: To assess the success rate of bCPAP therapy in neonates with RDS and determine factors influencing treatment outcomes. Study Design: A descriptive case series. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Narowal. Duration of Study: Six months, from March 7, 2023, to September 7, 2023. Methods: A total of 193 neonates diagnosed with RDS, meeting the inclusion criteria, were enrolled in the study. bCPAP failure was defined as the need for a fraction of inspired oxygen (FiO2) >40%, CPAP pressure >10 cm H₂O, surfactant administration, or mechanical ventilation. Data were collected on demographic and clinical parameters, including gestational age, birth weight, Apgar score, and Downe’s score. Statistical analysis was conducted using SPSS version 25. Data stratification was performed based on gender, age, birth weight, gestational age, Apgar score, and baseline Downe’s score. The Chi-square test was used to determine associations, with a p-value of ≤0.05 considered statistically significant. Results: Among the 193 neonates, 128 (66.3%) were male, and 65 (33.7%) were female. The mean age of neonates was 16.35 ± 6.534 days, with a mean gestational age of 35.41 ± 5.341 weeks. The mean birth weight was 2735.41 ± 18.413 grams. The mean Downe’s score at baseline was 7.48 ± 1.104, and the mean Apgar score was 7.55 ± 2.35. The success rate of CPAP therapy was observed in 176 (91.2%) neonates. Conclusion: bCPAP is a highly effective non-invasive respiratory support modality for neonates with RDS, demonstrating a high success rate. These findings underscore the importance of early CPAP intervention in reducing the need for mechanical ventilation. Further studies are warranted to explore factors influencing CPAP failure and optimize neonatal respiratory care strategies.

COMMON MODIFIABLE RISK FACTORS FOR STROKE

I KHAN — 2025-05-20

Background: Stroke remains a leading cause of morbidity and mortality worldwide. A substantial proportion of strokes are preventable through the management of modifiable risk factors. Early identification and control of these factors are essential for effective stroke prevention strategies. Objective: To assess the frequency of common modifiable risk factors among patients diagnosed with stroke. Study Design: Observational study. Setting: Department of Medicine at Khyber Teaching Hospital, Peshawar. Duration of Study: July 2024 to January 2025. Methods: A total of 120 stroke patients aged 45 years or older were included in the study. Stroke type was classified as ischemic or hemorrhagic based on clinical evaluation and confirmed via neuroimaging (CT or MRI). Data were collected on the presence of modifiable risk factors, including hypertension, diabetes mellitus, obesity, dyslipidemia, cardiovascular disease, smoking, and poor dietary habits. Descriptive statistics were used to report frequencies and percentages. Results: The mean age of patients was 57.95 ± 7.01 years. Of the total cases, 77.5% were ischemic strokes, and 22.5% were hemorrhagic. The most common modifiable risk factors identified were hypertension (53.3%), diabetes mellitus (38.3%), and obesity (20.0%). Conclusion: This study highlights a high prevalence of modifiable risk factors—particularly hypertension, diabetes, and obesity—among stroke patients. Targeted interventions aimed at controlling these factors may significantly reduce the burden of stroke in at-risk populations.

FREQUENCY OF METHOTREXATE INDUCED HEPATOTOXICITY IN PATIENTS WITH RHEUMATOID ARTHRITIS

I REHMAT — 2025-04-24

Background: Methotrexate (MTX) is a cornerstone drug in the management of rheumatoid arthritis (RA), but its use is associated with potential adverse effects, notably hepatotoxicity. Identifying the frequency and contributing factors to MTX-induced liver toxicity is essential for optimizing therapeutic safety in RA patients. Objective: To evaluate the frequency and associated risk factors of methotrexate-induced hepatotoxicity among patients with rheumatoid arthritis. Study Design: Descriptive cross-sectional study. Setting: This study was conducted at the Department of Medicine at Lady Reading Hospital, Peshawar. Duration of Study: The study was conducted over six months [11-September-2024 to 11-March-2025]. Methods: A total of 78 patients diagnosed with RA and undergoing MTX therapy, irrespective of age and gender, were enrolled. Hepatotoxicity was defined as serum alanine aminotransferase (ALT) levels exceeding twice the standard upper limit. Data regarding age, gender, MTX dosage, and liver function tests were recorded. Statistical analysis was performed using SPSS version 24. Chi-square and t-tests were used to assess associations, with a p-value ≤ 0.05 considered statistically significant. Results: The mean age of participants was 45.29 ± 12.38 years. Most were female (56.4%), while males accounted for 43.6%. Hepatotoxicity was observed in 19.2% of patients. A significant association was found between hepatotoxicity and higher MTX dosage (25 mg/week) (p = 0.01). No significant correlations were identified with age (p = 0.39) or gender (p = 0.39). Conclusion: Methotrexate-induced hepatotoxicity was found in nearly one-fifth of RA patients, with higher MTX doses significantly associated with liver enzyme elevation. These findings highlight the importance of regular liver function monitoring, particularly in patients receiving higher MTX dosages.

COMPARISON OF POST-OPERATIVE HOSPITAL STAY IN PERIUMBILICAL AND INTRAUMBILICAL INCISION IN LAPAROSCOPIC APPENDECTOMY

ZU REHMAN — 2025-05-30

Background: Laparoscopic appendectomy is a common surgical procedure, and the choice of umbilical incision type may influence postoperative recovery. While intraumbilical (IU) and periumbilical (PU) incisions are both widely used, comparative evidence regarding their impact on hospital stay and patient outcomes remains limited. Objective: To compare the postoperative hospital stay between intraumbilical and periumbilical incisions in patients undergoing laparoscopic appendectomy. Study Design: Comparative study. Setting: Department of General Surgery, Saidu Medical College and Teaching Hospital, Swat, Pakistan. Duration of Study: July 2024 to January 2025. Methods: A total of 150 patients aged 18 years and above undergoing laparoscopic appendectomy were enrolled and randomly allocated into two groups: Group A (n = 75) received intraumbilical (IU) incisions, while Group B (n = 75) underwent periumbilical (PU) incisions. Standardized laparoscopic techniques were used across both groups. IU incisions were made vertically within the umbilicus, and PU incisions were placed curvilinearly above or below the umbilicus. Primary outcome measured was length of postoperative hospital stay. Secondary outcomes included operative time and postoperative pain scores (measured using a visual analogue scale). Statistical analysis was performed using independent sample t-tests, with p < 0.05 considered statistically significant. Results: The mean hospital stay in Group A (IU) was 5.52 ± 0.87 days, compared to 5.55 ± 0.94 days in Group B (PU) (p = 0.85). Mean operative time was 86.40 ± 3.55 minutes in Group A and 86.32 ± 3.76 minutes in Group B (p = 0.89), indicating no significant difference. Pain scores were slightly higher in Group A (3.69 ± 0.91) than in Group B (3.40 ± 0.91), reaching borderline statistical significance (p = 0.05). Conclusion: Intraumbilical and periumbilical incisions yield comparable clinical outcomes in laparoscopic appendectomy, with no significant differences in hospital stay or operative time. Although pain scores were marginally higher in the intraumbilical group, both techniques can be safely and effectively utilized based on surgeon preference and patient-specific considerations.

ASSOCIATION OF NON-SECRETORY MULTIPLE MYELOMA AND HYPOTHYROIDISM: A RARE CASE REPORT

F SHAHZAD — 2025-06-20

One uncommon subtype of MM is non-secretory multiple myeloma (NSMM), and its main characteristic is the lack of observable monoclonal proteins. The coexistence of hypothyroidism and MM is very rare, and little is known about their interaction. Presentation of the case: A known case of hypothyroidism, presented with fever, shortness of breath, and fatigue. Lytic lesions on skull X-ray, lack of proteins on protein electrophoresis, and bone marrow biopsy confirmed the diagnosis. The patient was treated with cyclophosphamide and dexamethasone. Discussion: This case demonstrates how challenging it can be to identify NSMM, especially when typical MM symptoms are absent. Since the concurrence of MM and hypothyroidism is very uncommon, more research is required. Conclusion: This study highlights the need for a multidisciplinary approach for the diagnosis and treatment of rare MM variants due to their atypical presentations. Further study is required to elucidate the underlying mechanisms and therapeutic implications of this association.