Pakistan Journal of Intensive Care Medicine

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: Comparative observational study. Setting: The study was conducted in the Department of Neurosurgery at a tertiary care hospital. 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.

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.

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.

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.

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: Descriptive 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.

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.

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.

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.

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.

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.

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..

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.

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 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.

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.

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.

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: Descriptive 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.

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.