Pakistan Journal of Intensive Care Medicine

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.

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.

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.

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.

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.

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.

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.

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.

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: Prospective cohort study. Setting: The study was conducted in a hospital-based setting. 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.