Pakistan Journal of Intensive Care Medicine

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

S KHAN , A FARAZ — Mon, 14 Jul 2025 00:00:00 +0000

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

CONGENITAL ABNORMALITIES IN NEWBORNS OF CONSANGUINEOUS AND NON-CONSANGUINEOUS PARENTS

K SABAHAT , P NAVEED — Mon, 14 Jul 2025 00:00:00 +0000

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

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

ROOHULAMIN ., T NAWAZ , S MUHAMMAD , ASFANDIYAR ., F QUAID , H ALI — Fri, 18 Jul 2025 00:00:00 +0000

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

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

SU REHMAN , SI BUKHARI , Z KHAN , SHU SHAH — Mon, 14 Jul 2025 00:00:00 +0000

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

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

M ANEEQ , M ALI — Sat, 19 Jul 2025 00:00:00 +0000

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

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

F SHAH , AU HAQ — Mon, 14 Jul 2025 00:00:00 +0000

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

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

S KHAN , N ANWAR , AA KHAN , I MIRZA , T RASHID — Thu, 17 Jul 2025 00:00:00 +0000

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

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

MR IQBAL , U SAMAN , M WAQAS , M FAREED , AU HAQUE — Mon, 14 Jul 2025 00:00:00 +0000

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

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

A RAFIQUE , A HABIB , S MAJEED , M HAFEEZ , F JABEEN , TA MUNIR — Mon, 14 Jul 2025 00:00:00 +0000

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

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

MA SARWAR , S SALEEM — Mon, 14 Jul 2025 00:00:00 +0000

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

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

S KHAN , M MAHMOOD , BA KHAN — Thu, 10 Jul 2025 00:00:00 +0000

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

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

Y ABBAS , W KHAN — Tue, 15 Jul 2025 00:00:00 +0000

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

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

IA SHAH , N KHAN, M ASLAM , S WAHEED , B AHMAD , AMT HUSSAIN — Mon, 14 Jul 2025 00:00:00 +0000

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

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

N NOOR , S SALEEM , TA MUJAHID , MU GHANI — Sat, 19 Jul 2025 00:00:00 +0000

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

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

N ULLAH , H HASHIM , R USMAN , S ULLAH — Thu, 10 Jul 2025 00:00:00 +0000

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

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

S KHAN , SS JABEEN , M MUNIR , S FEROZ , S SULTAN — Mon, 14 Jul 2025 00:00:00 +0000

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

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

SM BILLAH , S SALEEM , A AMAR , MF MALIK, M RIZWAN, AA KHAN — Mon, 14 Jul 2025 00:00:00 +0000

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

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

M AMIN , F AMIN , AA ATHER , S AHMAD — Sun, 20 Jul 2025 00:00:00 +0000

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

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

UES RASHID , I ULLAH , I AHMAD, FU RAHMAN , K MANAN — Mon, 14 Jul 2025 00:00:00 +0000

ABSTRACT

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

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

K GUL , Y KHAN , M BILAL , AU KHAN , M SALMAN — Fri, 18 Jul 2025 00:00:00 +0000

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

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

A KARAMAT , S SARFRAZ , H IBRAHIM , A SAEED , SAR KHAN — Mon, 14 Jul 2025 00:00:00 +0000

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

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

SA KHAN , A SATTAR — Mon, 14 Jul 2025 00:00:00 +0000

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

FREQUENCY OF HYPERPARATHYROIDISM IN ADULT CHRONIC HEMODIALYSIS PATIENTS

A KHAN , N ANWAR , I MIRZA , T RASHID , N INAYATULLAH — Fri, 18 Jul 2025 00:00:00 +0000

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

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

SMSK QAISRANI , S NAZAR , M CHAUDHARY, A BASHIR — Sun, 20 Jul 2025 00:00:00 +0000

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

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

FU RAHMAN , MU RAHMAN , U SALMA , K MANAN — Thu, 17 Jul 2025 00:00:00 +0000

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

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

M NASEEM , F QURESHI — Mon, 14 Jul 2025 00:00:00 +0000

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

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

H ULLAH , S ALI , A ULLAH , M AFTAB — Mon, 14 Jul 2025 00:00:00 +0000

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

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

A AZIZ , W KHAN — Mon, 14 Jul 2025 00:00:00 +0000

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

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

A REHMAN , M SARWAR , S ABBAS , N SULTANA , A JAMIL , A PERVEZ — Mon, 14 Jul 2025 00:00:00 +0000

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

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

A AHMAD , Z ALI , A GUL , U HAFEEZ , S AHMAD , HU REHMAN — Mon, 21 Jul 2025 00:00:00 +0000

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

HYPONATREMIA FOLLOWING ANEURYSMAL SUBARACHNOID HEMMORHAGE

ZU REHMAN , B ULLAH , M AAMIR — Fri, 01 Aug 2025 00:00:00 +0000

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

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

H ULLAH , M KHAN , IU KHAN , H AMIN , A ULLAH , M KHAN , R RAHIM — Wed, 16 Jul 2025 00:00:00 +0000

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

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

M SALEEM , M JABIN — Tue, 15 Jul 2025 00:00:00 +0000

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

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

J ZAHID , F SHEHZAD , A SIDDIQA , RA RANA , A ZAHID , IA AZHAR — Fri, 18 Jul 2025 00:00:00 +0000

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

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

N QAYYUM , N REHMAN , A AMJAD , H HASSAN , T BIBI , SHAHINDA ., SH SHAH — Sun, 24 Aug 2025 00:00:00 +0000

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

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

MB YASIN , LT QADAR , MA RIAZ , MH HAFEEZ , M RAHEEL , F ASHFAQ — Tue, 15 Jul 2025 00:00:00 +0000

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