The Professional Medical Journal

Forensic jurisprudence of violence: Examining cause and consequence.

2025-06-25T04:31:10-07:00

Objective: This study is being conducted to highlight etiology of violence and what remedial measures can be adopted to alleviate law and order scenario. Study Design: Retrospective Observational study. Setting: Medicolegal Clinic of Emergency Department, Mayo Hospital Lahore. Period: January 1^st 2024 to 31^st December 2024. Method: A Retrospective observational study was conducted of cases reported in medicolegal clinic of Mayo Hospital Lahore in year 2024, including all physical assault, sexual assault and poisoning cases. Age, gender, occupation and educational status were the prime variables which were included in the study. Data was analyzed in IBM SPPS version 26.0 with cross tabulation and Pearson-Chi Square test was applied for significance value and correlation. Results: Total number of cases reported were 2233, of which 78.2% were male and only 21.8% were female, and 89.2% were of age of majority and 10.8% were of less than 18 years of age. Crime cases reported in the summer peaked up to 72% with a decline of violence tendency in the winter season with only 28% criminal activity. Pearson Chi-Square and Likelihood Ratio depict strength of association between categorical variables suggesting a stronger association of adults and violence with labor class most inclined to be aggressive followed by job oriented personnel. An extremely low p-value of 0.000 shows statistical significance of association. Conclusion: Violence is an unspoken unwelcome element of human life yet it needs to be addressed for remedial purposes. Education of the masses and awareness regarding the aftermath of a temporary bout of outburst can have lasting impact over one’s life especially the medicolegal, police and court proceedings which can have multiple burdens over an already busy lifestyle of any individual.

Still birth classification: Application of relevant condition at death (Recode) classification system in a Tertiary Care Hospital of Peshawar.

2025-07-21T06:21:05-07:00

Objective: To find the different causes of stillbirths at our institution, using the ReCoDe categorization system. Study Design: Prospective Observational study. Setting: Gynae A Unit of Obstetrics and Gynecology Department MTI/Khyber Teaching Hospital, Peshawar. Period: 1^st January 2021 to 31^st December 2023. Methods: Sampling method was consecutive non probability sampling. Patients diagnosed with stillbirth who were admitted to the hospital made up the study population. The patient's highrisk characteristics for pregnancy and delivery as well as the reason for the stillbirth were evaluated. Results: During the study period, 210 stillbirth cases in total met the inclusion criteria. There were 32416 live births in all during this time, or six stillbirths for every 1000 live births. The majority of women (80%) with in utero fetal demise fell within the age range of 20 to 35 years old, according to the age distribution of these cases. Thirteen percent of instances involved mothers above the age of twenty, and sixteen percent were older mothers. There were over 45.4% unbooked cases compared to 54.5% booked hospital cases. Fetal causes accounted for 34.6% of intrapartum deaths, with IUGR making up the largest group (23.5%). Maternal factors accounted for 30.4% of stillbirths; pre-eclampsia was the most often reported comorbidity. 18.8% of cases fell into the unclassified category when no other cause could be identified. Conclusion: Classification of stillbirths using ReCoDe classification is simple and practical to use, especially in low-resource settings, with the ability to identify underlying cause in the majority of cases.

Frequency of various histopathological types of ovarian tumors reported at a Tertiary Care Hospital, Karachi, Pakistan.

2025-07-01T07:19:11-07:00

Objective: To determine the frequency, histopathological spectrum, and clinical characteristics of ovarian tumors at a tertiary care hospital of Karachi, Pakistan. Study Design: Retrospective, Cross-sectional study. Setting: Department of Obstetrics & Gynaecology, Ward-8, Jinnah Postgraduate Medical Centre, Karachi, Pakistan. Period: 1^st January 2022 to 30^th December 2024. Methods: Data of 204 female patients diagnosed with ovarian tumors (benign or malignant), and underwent surgical management with complete clinical and histopathological records were analyzed. Data regarding demographics, clinical information, disease biomarkers and histopathology details were noted. Data were analyzed using SPSS version 26. Chi-square test was used to evaluate associations between clinical features and malignancy, taking p<0.05 as significant. Results: In a total of 204 women, the mean age was 39.38±12.16 years. Among 204 cases, 98 (48.0%) were benign, and 106 (52.0%) malignant. The most frequent benign tumor was serous cystadenoma 30 (14.7%) and the most common malignant tumor was mucinous cystadenocarcinoma (20.6%), followed by high-grade serous carcinoma, in 22 (10.8%) cases. Most malignant tumors presented at FIGO stage III, 46 (22.5%). Elevated CA-125 levels were noted in 117 (57.4%) cases. Significant associations were found between malignancy and menopausal statu (p<0.001), comorbidities (p<0.001), raised tumor markers (p<0.001), and positive family history (p<0.001). Upfront surgery was performed in 109 (53.4%) cases, while 46 (22.5%) received neoadjuvant chemotherapy followed by surgery. Conclusion: This retrospective cross-sectional study highlights the considerable burden and diverse histopathological spectrum of ovarian tumors at a tertiary care center in Karachi, Pakistan.

Investigating the association between PCOS (Polycystic Ovary Syndrome) and pregnancy complications: A cohort study.

2025-08-04T04:20:06-07:00

Objectives: The basic aim of the study is to identify the correlation between PCOS and pregnancy complications. Study Design: Retrospective Cohort study. Setting: Shahida Islam Medical Complex. Period: September 2024 and June 2025. Methods: The cohort used 405 women who were pregnant. This is considered a retrospective study that used medical records to analyze data in a tertiary care hospital across a given period of study. Important data were focused on demographic data, e.g., age, body mass index (BMI), and parity, pre-existing medical conditions, e.g., hypertension or diabetes. Results: Women in the PCOS group had a higher mean Body Mass Index (BMI) (28.7 ± 5.3 kg/m²) compared to the control group (25.6 ± 4.9 kg/m², p < 0.001), with a significantly greater prevalence of obesity (45% vs. 25%, p < 0.001). Although the mean age (30.4 ± 4.8 years vs. 29.9 ± 4.5 years), gravidity (2.3 ± 1.1 vs. 2.1 ± 1.0), parity (1.2 ± 0.9 vs. 1.1 ± 0.8), and smoking status (12% vs. 10%) were slightly higher in the PCOS group, these differences were not statistically significant (p > 0.05). Preterm delivery occurred in 22% of PCOS pregnancies compared to 10% in the control group (p < 0.01), and cesarean deliveries were also more frequent among women with PCOS (42% vs. 28%, p < 0.01). Conclusion: It is concluded that Polycystic Ovary Syndrome (PCOS) is significantly associated with adverse pregnancy outcomes, including gestational diabetes, hypertensive disorders, preterm delivery, and neonatal complications such as low birth weight and NICU admissions.

Histopathological patterns of ovarian neoplasms: A retrospective study from a Tertiary Care Centre in Pakistan.

2025-05-21T02:27:40-07:00

Objective: To evaluate the histopathological patterns of ovarian neoplasms and compare findings with the national and international literature. Study Design: Retrospective Descriptive study. Setting: Department of Pathology, Dow University of Health Sciences, Karachi. Period: January 2019 to December 2023. Methods: Histopathological reports of all ovarian biopsies diagnosed as neoplastic lesions, were included. Data on age, marital status, presenting complaints, and tumour type were recorded and categorised per the WHO classification. Tumours were further grouped into epithelial, germ cell, and sex cord-stromal types. Age stratification was done into pre-reproductive, reproductive, and post-reproductive groups. Results: A total of 319 ovarian neoplasms were studied. The mean age was 37.35 ± 13.725 years, with most patients in the reproductive age group (71.5%). Benign tumours were predominant (77.4%), followed by malignant (17.8%) and borderline (4.7%) lesions. The most common benign tumour was mature teratoma (28.8%), followed by serous cystadenoma (22.2%) and mucinous cystadenoma. Conclusion: Ovarian neoplasms chiefly affect women in their reproductive age and are predominantly benign. The most common benign tumour was mature teratoma (28.8%), Histopathological evaluation remains crucial for diagnosis and management. Understanding these patterns can guide clinicians toward timely and effective treatment strategies.

Incidence of tertiary hyperparathyroidism in CKD patients on hemodialysis.

2025-06-27T05:28:09-07:00

Objective: This study aimed to determine the incidence of tertiary hyperparathyroidism (THPT) among chronic kidney disease (CKD) patients on long-term hemodialysis in Swat, Pakistan, and identify key risk factors and complications. Study Design: Cross-sectional study. Setting: Miangul Abdul Haq Jahanzeb Kidney Teaching Hospital, Manglor Swat. Period: Jan and Feb 2025. Methods: A total of 200 adult hemodialysis patients (≥5 years) were screened. THPT was diagnosed based on persistently elevated parathyroid hormone (PTH) levels (>300 pg/mL), hypercalcemia (>10.5 mg/dL), and phosphate imbalance. Statistical analysis included independent t-tests, Chi-square tests, and binary logistic regression. Results: The incidence of THPT was 36% (n=72). Significant predictors included dialysis duration >10 years (OR: 2.67; p<0.001), PTH >300 pg/mL (OR: 3.21; p<0.001), hypercalcemia (OR: 2.89; p<0.001), and lack of vitamin D therapy (OR: 1.98; p=0.002). THPT patients exhibited higher rates of vascular calcifications (48% vs. 22%), fractures (12% vs. 3%), and gastrointestinal complications (18% vs. 7%) (p<0.05). Conclusion: The high burden of THPT (36%) among hemodialysis patients highlights the need for early screening, vitamin D supplementation, phosphate control, and timely parathyroidectomy referrals to mitigate complications.

Exploring the lived experiences of patients with liver cirrhosis: A phenomenological study from Pakistan.

2025-04-04T04:38:58-07:00

Objective: To investigate the lived experiences of cirrhotic patients in Pakistan, with an emphasis on their physical, emotional, social, and spiritual struggles, while also analyzing the coping strategies they adopt to navigate and manage their condition. Study Design: Qualitative Phenomenological study. Setting: The study took place at the Liver Transplant Department of Pir Abdul Qadir Shah Institute of Medical Sciences, Gambat, Pakistan. Period: May and June 2024. Methods: Involving eight purposively selected patients diagnosed with Child-Pugh class C liver cirrhosis. Data collection occurred through in-depth, semi-structured interviews. The interviews were analyzed using Colaizzi’s seven-step method, and thematic analysis was utilized to uncover key themes reflecting the patients’ experiences. Results: Six major themes and 13 sub-themes were identified. Patients initially experienced shock and disbelief upon diagnosis. Physical challenges included fatigue, weakness, chronic pain, and cognitive decline. Emotional distress was characterized by fear, anxiety, and depression, while family support emerged as a critical coping mechanism. Social withdrawal and isolation were common, driven by stigma and physical limitations. Many patients relied on religious beliefs for strength, while some struggled with feelings of hopelessness. Healthcare experiences varied, with some reporting satisfaction and others highlighting barriers such as financial constraints and limited access to specialized care. Conclusion: Patients with liver cirrhosis face significant physical, emotional, and social burdens, often alleviated by familial and religious support. Healthcare professionals should integrate psychosocial interventions and family-centered education programs to enhance patient well-being. Addressing financial and accessibility barriers is also crucial in improving such patients care.

Pattern of bacteriology and antibiotic sensitivity in admitted patients of urinary tract infections.

2025-07-26T07:54:03-07:00

Objective: To find out frequency of type of bacteria and antibiotic sensitivity in admitted patients of urinary tract infections. Study Design: Cross-sectional study. Setting: Medical Emergency Ward and Medical Unit-II, Allied Hospital, Faisalabad. Period: 01-01-2023 to 30-06-2023. Methods: Eligible patients were recruited in the research. History After, physical, and urine analysis diagnosed urinary tract infection. Bacteria were tested after 24 hours. If no growth was found, material was stored for 24 hours and lab report was retrieved after 48 hours. Every antibiotic's inhibition zone was assessed and sensitivity was reported. Results: Mean age was 42.62+12.29 years, 31 (20.7%) were male, 119(79.3%) were female. E.coli was isolated in 65 (43.3%) cases, Coagulase Negative Staphylococci (CONS) was isolated in 70 (46.7%), Enterococcus in 6 (4%), and S.Aureus in 9 (6%) cases. Conclusion: We concluded that Coagulase Negative Staphylococci (CONS) and E.Coli as the leading type of bacteria found UTI whereas Nitrofurantoin, Ciprofloxacin, Cefotaxime and Vancomycin are highly sensitive for these pathogens.

Serum magnesium levels and its association with severity of asthma.

2025-06-28T04:47:30-07:00

Objective: To determine the serum magnesium levels and its association with asthma severity among children presenting with asthma. Study Design: Cross-sectional study. Setting: Department of Pediatrics, National Institute of Child Health, Karachi, Pakistan. Period: October 2024 to March 2025. Methods: A total of 151 children aged 6–15 years with asthma were enrolled using non-probability consecutive sampling. Serum magnesium was measured using atomic absorption spectrophotometry. Asthma severity was categorized according to GINA guidelines. Data were analyzed using SPSS version 26.0. Frequencies and percentages were calculated for categorical variables, whereas numerical variables were presented as mean ± standard deviation or median with inter-quartile range (IQR), as per normality distribution. ANOVA/Kruskal-Wallis, and chi-square/Fisher’s exact tests assessed associations, with p<0.05 considered significant. Results: Of 151 children, 103 (68.2%) were male, and the median age was 10 years. Cough (70.9%), shortness of breath (14.6%), and difficulty in breathing (12.6%) were common. The median serum magnesium level was 2.10 (IQR: 2.00-2.30) mg/dl. Asthma severity was mild in 61 (40.4%), moderate in 68 (45.0%), and severe in 22 (14.6%) cases. Serum magnesium levels declined significantly with increasing asthma severity as median 2.12 mg/dl in mild, 2.10 mg/dl in moderate, and 2.00 mg/dl in severe asthma (p=0.004). Allergic rhinitis (p=0.016), and inpatient care (p<0.001) were associated with significantly lower magnesium concentrations. Conclusion: The present study demonstrates that lower serum magnesium levels are significantly associated with greater severity of asthma among children.

Biochemical markers in the Wilson’s disease patients in adolescents presenting at tertiary care hospital.

2025-08-09T06:24:49-07:00

Objective: Estimating biochemical markers in Wilsons disease (WD) patients in adolescents group presenting at tertiary care hospital. Study Design: Cross Sectional study. Setting: Outpatients and Medical Wards, Isra University Hospital. Period: January 2024 to March 2025. Methods: One hundred diagnosed cases of WD were enrolled for estimating the biochemical markers of copper metabolism in adolescents. Cases were diagnosed and reconfirmed by a consultant physician. Blood sample were taken. Sonography was ordered. Biochemical parameters were estimated by Roche Cobas Chemistry Analyser and Atomic spectrophotometry. Variable were analyzed on SPSS 21.0 ver. P – value is taken at (USA) at 95% CI (P≤ 0.05). Results: Age was 17.31±7.97 years. Male - female ratio was 3:1. Icteric sclera was noted in 57 cases, hepatomegaly in 69 cases, splenomegaly in 71 cases, and KF rings noted in 21 cases. 24 hour urinary copper measured as 2913.5± 711.6 (409 – 3901) mg/dl serum ceruloplasmin measured as 17.01±54.87 mg/day. Conclusion: We observed low ceruloplasmin and high urinary copper in WD patients. Penicillamine challenge show high 24 – hour urinary copper excretion.

Radiological and histopathological analysis of diffusely abnormal white matter in chronic multiple sclerosis.

2025-06-28T05:03:16-07:00

Objective: To characterize DAWM in chronic MS through advanced MRI techniques and histopathological evaluation, and to compare it with NAWM and focal white matter lesions. Study Design: Retrospective Observational study. Setting: Bajwa Trauma Centre and Teaching Hospital, Sargodha. Period: 01-10-2024 to 01-04-2025. Methods: analyzed postmortem brain tissue from 20 formalin-fixed brain slices of 10 chronic MS patients using 0.7 T and 1.5 T MRI, combined with histological staining and immunohistochemistry. Quantitative MRI parameters (T1, T2, FA, ADC, MTR) and histological markers (axonal count, myelin density, gliosis, microglial activation) were assessed and correlated. Results: DAWM showed intermediate MRI and histopathological features between NAWM and focal lesions. T1 and T2 relaxation times were significantly elevated in DAWM, while FA and MTR were reduced (p < 0.001). Histologically, DAWM exhibited 40% fewer axons and 11% lower myelin content than NAWM, but less damage than focal lesions (66% axonal loss, 22% myelin reduction). Gliosis and microglial activity were pronounced in DAWM. Strong correlations were found between imaging metrics and histological markers (T1 with axonal loss, r = 0.82; FA with myelin density, r = –0.75). Conclusion: DAWM represents a unique and chronic degenerative component of MS, distinct from both NAWM and focal lesions. Its imaging and histological profiles suggest an ongoing, diffuse process of axonal and myelin loss, with implications for disease progression and disability. Incorporating DAWM analysis into MS diagnostics could improve monitoring and treatment strategies.

Topical tranexamic acid compared with anterior nasal packing treatment of epistaxis in patients taking antiplatelet drugs.

2025-05-07T06:31:23-07:00

Objective: To evaluate the effectiveness of anterior nasal packing and topical tranexamic acid in treating epistaxis in patients on antiplatelet medications. Study Design: Randomized Controlled Trail. Setting: Emergency Department of Ziauddin University Hospital, Karachi. Period: 21-5-2024 to 5-5-2025. Methods: Those patients who presented with anterior epistaxis were randomised by using the lottery method to receive anterior nasal packing (ANP) or topical application of tranexamic acid (TXA), with 30 patients in each group. In the case group, patients were treated with topical tranexamic acid, while in the control group, patients were treated with ANP. The Statistical Package for Social Sciences (SPSS version 25) was utilized for interpretation of collected data. Results: Of the 60 epistaxis patients, majority of epistaxis patients were male (55.0%, n=33), and the remaining were female (45.0%, n=27), with an average age of 59.2 ± 8.3 years. Mean cessation time of bleeding in epistaxis patients was 7.1 ± 3.4 min in the case (TXA) group and 13.4 ± 4.9 min in the control (ANP) group (p-value < 0.001). Length of stay in ED in epistaxis patients was significantly lower in the case (TXA) group as compared to the control (ANP) group (p-value=0.042). Rebleeding in epistaxis patients occurred in 10.0% (n=3) in the case (TXA) group and 40.0% (n=12) in the control (ANP) group (p-value=0.007). Treatment in epistaxis patients was satisfactory in 90.0% (n=27) in the case (TXA) group and 66.7% (n=20) in the control (ANP) group (p-value=0.028). Conclusion: The use of topical tranexamic acid instead of anterior nasal packing for the treatment of epistaxis in patients who were on antiplatelet drugs is associated with significantly shorter duration of bleeding control, fewer rebleeding episodes, decreased length of ED stay, and greater satisfaction.

Comparative analysis of mother’s own milk, donor human milk and mix of both: Impact on growth.

2025-07-19T04:03:31-07:00

Objective: To compare the impact of mother’s own milk (MOM), donor milk (DM), and mixed milk (MM) on key growth parameters in preterm neonates. Study Design: Randomized Controlled Trial. Setting: The Neonatal Intensive Care Unit (NICU) at Recep Tayyip Erdogan Hospital, Muzaffargarh, Punjab, Pakistan. Period: During 1st August 2024 to 30th January 2025. Methods: Ninety preterm neonates (28–32 weeks gestation, 800–2000 grams birth weight) were randomized to receive MOM, DM, or MM. Detailed demographic, anthropometric, and clinical data were collected at admission, and at discharge. Data were analyzed using IBM-SPSS v26.0, with appropriate statistical tests, and significance was set at p<0.05. Results: Among 90 enrolled preterm neonates, 53 (58.9%) were male, and 37 (41.1%) female. The median postnatal age was 12.0 (IQR 10.0–14.0) days, and gestational age was 30.0 (28.0–30.0) weeks. Baseline weight, length, and head circumference were 1200 g (1000–1300), 38.0 cm (36.0–40.0), and 29.0 cm (28.0–30.0), respectively. At discharge, median weight was 1500 g (1300–1725) in the MOM group, 1450 g (1157–1525) in the DM group, and 1350 g (1200–1600) in the MM group (p=0.122). Median length was 42.5 cm (41.0–46.0), 43.0 cm (41.0–45.0), and 42.0 cm (40.0–43.0), respectively (p=0.171). Head circumference medians were 31.0 cm (30.0–32.0) in MOM and MM, and 31.0 cm (30.0–31.0) in DM (p=0.546). Conclusion: This study supports the use of donor milk and mixed feeding strategies as safe and effective alternatives to exclusive maternal milk feeding, particularly when supported by appropriate fortification and clinical protocols.

Prognostic factors and outcome of neonatal tetanus.

2025-07-14T04:38:44-07:00

Objective: To determine prognostic factors and outcome of neonatal tetanus (NT). Study Design: Analytical, Cross-sectional study. Setting: Neonatal Intensive Care Unit (NICU) of the National Institute of Child Health, Karachi, Pakistan. Period: January 2024 to March 2025. Methods: A total of 154 neonates (gestational age > 34 weeks) admitted to the NICU due to NT for more than 24 hours were studied. Outcomes in terms of discharged or mortality were assessed. Data were analyzed using IBM-SPSS version 26.0. For all inferential statistics computed by applying chi-square test, fisher’s exact test or independent sample t-test (as appropriate), p<0.05 was considered as statistically significant. Results: Of 113 neonates with tetanus, 18 (15.9%) were discharged while 95 (84.1%) died. Survivors had a higher mean age at presentation (12.11±1.91 vs. 8.54±3.08 days, p<0.001), and longer incubation period (10.20±2.18 vs. 4.38±2.69 days, p<0.001). Severe disease (p<0.001), lack of maternal immunization (p=0.009), and use of a blade for cord cutting (p=0.006), were associated with higher mortality. Mechanical ventilation was required in all non-survivors (100% vs. 77.8%, p<0.001). Survivors had a longer total hospital stay (18.94±5.48 vs. 15.08±4.75 days, p=0.003). Conclusion: Neonatal tetanus remains a devastating disease in the Pakistani context, with a persistently high case fatality. Early age at presentation, short incubation period, severe clinical disease, non-immunized mothers, unsafe delivery practices, and use of unsterilized tools for cord cutting are the dominant prognostic factors for mortality.

Association of left ventricular dysfunction with pediatric sepsis.

2025-07-14T04:32:31-07:00

Objective: To explore the relationship between left ventricular dysfunction (LVD) and clinical outcomes in children with severe sepsis or septic shock. Study Design: Cross-sectional study. Setting: Department of Pediatrics and Pediatric Intensive Care Unit (PICU), Ziauddin Hospital, Karachi, Pakistan. Period: December 2024 to June 2025. Methods: A total of 122 children aged 1 month to 18 years with severe sepsis or septic shock were analyzed. Outcomes assessed were need for mechanical ventilation, PICU stay, and mortality. Data were analyzed using SPSS v26, with frequencies for categorical variables, means for continuous data. Chi-square/Fisher’s exact or t-tests were used, with significance at p<0.05. Results: Among 122 children, the mean age was 4.8±2.5 years, while 68 (55.7%) children were female. There were 63 (51.6%) children who had severe sepsis, and 59 (48.4%) with septic shock. Septic shock cases had lower systolic (90.5±25.7 vs 112.8±33.3 mmHg, p=0.001) and diastolic blood pressure (55.9±16.5 vs 70.2±24.7 mmHg, p<0.001), higher heart rate (151.9±27.9 vs 134.2±37.1 bpm, p=0.004) and respiratory rate (47.1±10.6 vs 39.9±15.9, p=0.006). LVDD was present in 77 (63.1%) and RVDD in 67 (54.9%), without any significant differences. There was no statistically significant differences with respect to mortality (p=0.110). Conclusion: Left ventricular diastolic dysfunction was highly prevalent among children with pediatric sepsis. Children with septic shock demonstrated significantly greater hemodynamic compromise.

Effect of adjuvant zinc therapy on recovery from pneumonia.

2025-06-28T04:53:23-07:00

Objective: To study the effect of zinc supplementation as an adjuvant therapy on the outcomes of pneumonia. Study Design: Randomized Controlled Trial. Setting: Department of Pediatrics, National Institute of Child Health, Karachi, Pakistan. Period: November 2024 to April 2025. Methods: A total of 50 patients (25 in each group) children, aged 2 months to 5 years, and admitted with pneumonia were randomly allocated to either Group-A (Zinc + standard treatment) or Group-B (standard treatment only). In Group-The primary outcome was recovery rate, assessed by the resolution of tachypnea, chest indrawing, hypoxemia, and fever within 48 hours. Secondary outcomes included hospitalization duration and symptom recovery time. Results: In a total of 50 children, the mean age in Group-A was 2.8±1.2 years, and in Group B, 2.9±1.3 years (p=0.582). Gender distribution was statistically similar among study groups (p=0.827. Recovery rates were significantly higher in Group-A for fever (88% vs. 64%, p=0.001), tachypnea (84% vs. 56%, p=0.005), chest indrawing (72% vs. 48%, p=0.011), and hypoxemia (76% vs. 52%, p=0.009). The median duration of hospitalization in Group-A was 4.0 days (3.0–5.0 days), significantly shorter than the 6.0 days (5.0–7.0 days) observed in Group B (p=0.003). Conclusion: Zinc supplementation significantly improved recovery rates, reduced hospitalization duration, and accelerated the resolution of clinical symptoms, providing important clinical benefits.

Short-Term outcomes in patients with center-involving diabetic macular edema after a single dose of Intravitreal Bevacizumab.

2025-07-01T07:24:25-07:00

Objective: To evaluate short-term outcomes in patients with center-involving diabetic macular edema (ciDME) after a single dose of intravitreal bevacizumab (IVB). Study Design: Descriptive Study. Setting: Department of Ophthalmology, Hayatabad Medical Complex, Peshawar. Period: 19^th September 2024 to 19^th March 2025. Methods: A total of 140 patients with type 2 diabetes mellitus and ciDME were included using a nonprobability consecutive sampling technique. Patients who had received prior anti-vascular endothelial group factor therapy, intraocular steroids, or retinal laser treatment within the past year were excluded. Pre-injection and post-injection best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured using the Snellen chart and optical coherence tomography (OCT), respectively. Statistical analysis was performed using SPSS version 23. Results: A total of 140 patients were included, with a male-to-female ratio of 60:40. The median (IQR) age was 58.50 (8.75) years. CMT significantly decreased from 468.7 (42.9) µm pre-injection to 441.8 (42.42) µm post-injection (p = 0.001), indicating a significant anatomical response. The median BCVA pre- and post-injection remained 0.780, but the Wilcoxon Signed-Rank test showed a significant p-value of 0.001, suggesting subtle visual function changes. Age and gender did not significantly impact BCVA or CMT outcomes (p > 0.05). Conclusion: A single dose of intravitreal bevacizumab significantly reduces central macular thickness in patients with center-involving diabetic macular edema. While BCVA changes were statistically significant, they remained clinically limited over a short-term follow-up. Age and gender did not influence treatment response.

Clinico-radiologic patterns and BMI association in degenerative disease of the lumbosacral spine: A retrospective MRI study from a tertiary care hospital in Pakistan.

2025-08-06T06:09:27-07:00

Objective: To assess the clinico-radiologic patterns of lumbar spine degeneration as seen on MRI and to examine their association with different BMI categories among adult patients presenting with backache at a tertiary care hospital in Peshawar, Pakistan. Study Design: Retrospective study. Setting: LRH, Peshawar. Period: September 2022 to September 2024. Methods: Included 140 patients who reported lower back pain and underwent lumbosacral spine MRI. MRI findings were assessed at each spinal level and analyzed in relation to patients' BMI, which was classified according to WHO standards. Descriptive statistics, chi-square tests, and BMI-based distribution analyses were carried out. Results: The average age of participants was 41.8 years (SD = 13.3), with females making up 51% of the sample. The mean BMI was 28.6 kg/m² (SD = 4.98), and 68.5% of patients were either overweight or obese. MRI results showed a progressive increase in degenerative changes from the upper to the lower lumbar spine. The L4–L5 level exhibited the most frequent findings (72.1% diffuse bulge), followed by L5–S1 (28.6% diffuse bulge and 21.4% central herniation). Significant associations were observed between BMI and disc pathology at the upper lumbar levels, specifically at L1–L2 (p = 0.0207) and L2–L3 (p = 0.0048). No statistically significant correlation was found at the lower lumbar levels. Conclusion: Higher BMI appears to be linked with early-stage disc degeneration, particularly in the upper lumbar spine. Encouraging weight control and early lifestyle modifications may help reduce the burden of lumbar disc disease, especially in overweight and obese individuals.

Neurological outcomes following Morley procedure in traumatic dorso-lumbar fractures: An analysis of anterolateral corpectomy and fixation.

2025-06-23T04:40:35-07:00

Objective: Asses the follow up results of anterolateral approach. Study Design: Descriptive Type Research. Setting: Department of Neurological, Jinnah Post graduate Hospital Karachi. Period: March 2019 to December 2024. Methods: Patients from both genders, the Frankel's grading scale was used for thoracic and lumber trauma, including the X-ray and MRI were done for diagnostic purpose. Results: This study had 61 patients, those who had presented with thoracic either lumber spine injury had Webb Morley procedure. We had 14 (22.95%) female patients and 47(77.18%) males, a median group age value was 54.5yrs and the mean value age group was calculated 46±2 years. The mode of trauma was with Fall 36 (77.00%) followed by, a road trauma around 17(25 %), and objects fall 8 (17.18 %). The presentation of the patient was with backpain, sensory loss, splinter function involvement and weakness of the lower limb with different level of power and sensory loss. Conclusion: Patients undergoing this approach have shown significant neurological and functional improvement, especially those presenting with partial motor deficits. These individuals often experience substantial pain relief and effective control of kyphotic deformity progression. Selectivity plays pivotal role.

Outcomes of proximal femoral nailing in adults treated for subtrochanteric femur fractures.

2025-05-26T04:21:51-07:00

Objective: To assess the functional & radiological outcomes of proximal femoral nailing (PFN) in treating subtrochanteric femur fractures in adults. Study Design: Prospective study. Setting: Afridi Medical centre & Teaching Hospital Peshawar Pakistan. Period: Jan 2022 to October 2024. Methods: Patients of age 20 to 80 years admitted due to acute subtrochanteric (ST) femur fractures were included in the study. Open & pathological ST fractures were excluded. The Harris Hip Score was utilised to assess the postoperative outcomes. In all the cases, patients were put on immobilization preoperatively followed by closed reduction & fixation with PFN under spinal anaesthesia. Both radiological outcome by examining radiological union at fracture site and functional outcome through determining Harris Hip Score were determined at 4 months postoperatively. Microsoft excel was used for data analysis. Results: Radiological union was observed in the patients as early as 14 weeks postoperatively followed by radiological union in all the patients at 16th week postoperatively and no non-union case was observed in our study. Out of all 91 cases only 5 cases were having mild surgical site infection which was managed accordingly the sterile dressing and oral antibi.=otics. The overall Harris hip score to be 90.75±6.85 in our study. Among total 91 patients 68 (74.72%) patients fall in excellent, 15 (16.48%) in good, 6 (6.6%) in fair while 2 (2.2%) in poor categories of Harris hip score. Conclusion: PFN is an effective implant for treating femoral subtrochanteric fractures. The advantages include reduced surgical exposure, increased stability, and early mobilisation. Because it allows for early and stable mobilization, PFN may be superior for treating subtrochanteric fractures in the elderly as well.

Facet joint osteoarthritis as a predictor of surgical strategy and outcomes in lumbar disc herniation.

2025-08-04T04:13:04-07:00

Objective: To evaluate the association between lumbar facet joint osteoarthritis and the choice of surgical strategy as well as postoperative outcomes in patients undergoing surgery for lumbar disc herniation. Study Design: Retrospective Observational Research. Setting: Doctors Hospital and Medcial Centre Lahore. Period: 15^th March 2024 to 14^th March 2025. Methods: Involved 83 patients treated with surgical intervention concerning single-level LDH. Preoperative MRI was applied to evaluate FJOA based on the Weishaupt classification and disc degeneration based on the Pfirrmann grading system. The clinical outcomes were recorded in the Oswestry Disability Index (ODI) and EQ-5D scores, while radiographic outcomes included vertebral slip and Cobb angle. Statistical analysis was performed to examine associations between FJOA severity and surgical outcomes. Results: Weishaupt Grade 1 and 2 facet joint degeneration were most common, seen in 43.4% and 30.1% of patients, respectively. Grade 3 degeneration showed the highest mean facet tropism (8.12°). Pfirrmann Grade 3 and 4 disc degeneration was predominant. Significant postoperative improvement was observed in ODI (mean change: 21.5, p < 0.001) and EQ-5D (mean change: 0.25, p < 0.001). Although there was a significant increase in vertebral slip (mean change: 0.6 mm, p < 0.001), no significant change was found in dynamic slip or Cobb angle, indicating preserved spinal alignment. Conclusion: Facet joint osteoarthritis, particularly in its moderate to severe forms, is highly prevalent in patients with LDH and is associated with increased facet asymmetry. However, with appropriate surgical planning, including facet-sparing techniques, favorable clinical outcomes can still be achieved without compromising spinal stability. Preoperative assessment of facet pathology can guide surgical decision-making and optimize patient outcomes.

Functional outcome of intertrochanteric fractures of hip treated with Proximal Femoral Nail Antirotation II (PFNA-2).

2025-05-12T07:49:30-07:00

Objective: To evaluate the functional outcomes and complication rates in patients with unstable intertrochanteric fractures treated with PFNA-2. Study Design: Retrospective study. Setting: Department of Orthopedics, Ghurki Trust and Teaching Hospital, Lahore. Period: January 2022 and December 2023. Methods: 86 patients (46 men and 40 women) with unstable intertrochanteric femur fractures treated with PFNA-2. For a year, the patients were monitored. Twelve months after surgery, the Modified Harris Hip Score (MHHS) was used to evaluate functional results. Results: The mean age of patients was 73.53 ± 16.66 years. Post-operatively, the mean MHHS was 80.38 ± 9.28. Functional outcomes were excellent in 16 patients (18.6%), good in 42 patients (48.8%), fair in 24 patients (27.9%), and poor in 4 patients (4.7%). Postoperative complications were observed in 8 patients (9.3%), including 4 cases of helical screw back-out (4.7%), 2 cases of cellulitis (2.3%), and 2 cases of deep vein thrombosis with cellulitis (2.3%). Conclusion: PFNA-2 demonstrates good functional outcomes and a low complication rate in handling unstable intertrochanteric fractures, particularly in the elderly. Its biomechanical advantages and minimally invasive nature make it a favorable option for surgical fixation.

Association of uncontrolled blood pressure with diabetic nephropathy in patients of type 2 diabetes mellitus.

2025-07-19T06:38:13-07:00

Objective: To find the association between uncontrolled BP and diabetic nephropathy in patients with T2DM. Study Design: Cross-sectional Analytical study. Setting: Khawar Surgical Centre, Khanewal. Period: January 2024 to March 2025. Methods: A total of 355 patients with type 2 diabetes mellitus (T2DM) were enrolled using non-probability consecutive sampling. Data were collected on demographics, BP records, HbA1c, urinary albumin-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR). BP was categorized as controlled (<130/80 mmHg) or uncontrolled (≥130/80 mmHg). Diabetic nephropathy was defined by UACR ≥30 mg/g or eGFR <60 ml/min/1.73 m². Results: Diabetic nephropathy was present in 178 patients (50.1%), with a significantly higher prevalence in the uncontrolled BP group (62.4%) compared to the controlled group (31.7%) (p < 0.001). The uncontrolled BP group had higher mean UACR (68.5 ± 35.4 mg/g vs. 41.2 ± 23.1 mg/g) and lower eGFR (63.4 ± 15.7 vs. 77.6 ± 13.9 ml/min/1.73 m²) (both p < 0.001). Logistic regression confirmed uncontrolled BP as an independent predictor of diabetic nephropathy (OR = 3.61; 95% CI: 2.35–5.56; p < 0.001). Conclusion: Uncontrolled blood pressure is strongly associated with increased risk of diabetic nephropathy in patients with Type 2 Diabetes Mellitus. These findings reinforce the importance of integrating strict blood pressure control into standard diabetic management to reduce the risk of renal complications.

Clinico-Hematological profile and treatment outcome of chronic lymphocytic leukemia: A single center study from Pakistan.

2025-02-21T05:24:42-08:00

Objective: To evaluate clinical, hematological characteristics and treatment outcome of CLL patients in Pakistan. Study Design: Prospective Cross Sectional study. Setting: National Institute of Blood Diseases and Bone Marrow Transplantation (NIBD), Karachi, Pakistan. Period: January 2023 to November 2024. Methods: A total of 86 patients were included. The data was analyzed by using SPSS version 23.0. Comparative analysis was performed by using the log-rank test. The p-value of 0.05 was considered statistically significant. Overall survival was calculated by using the Kaplan-Meier method. Results: The study included 86 CLL patients with a median age of 59 years (IQR: 50-65 years). The male-to-female ratio was 1.86:1. Twenty-five (29.06%) patients were asymptomatic, while fatigue was the most common symptom observed in 40(46.9%) patients. Lymphadenopathy was seen in 60 (69.8%) patients with elder predominance (p = 0.038). Forty-five (52.3%) patients had anemia however, thrombocytopenia was observed in 18(20.9%) patients. Twenty-eight (32.5%) patients presented at higher-risk rai stage. A total of 61(70.9%) patients required treatment with a median interval of 4 months after diagnosis. Chlorambucil (47.4%) and ibrutinib (37.70%) were the most common regimens administered. The overall survival rate was higher in age group <55 years (74%) as compared to the elder group which was 47%. (p-value 0.072). Conclusion: Our study revealed that CLL in Pakistan mainly affects older adults, particularly male as seen in the western world. However, the clinical and hematological characteristics of our patients differ from existing literature. Further multicenter studies with larger sample size and prognostic biomarkers are needed to enhance risk stratification and treatment efficacy.

Frequency of thyroid disorders in children with obesity.

2025-07-14T04:20:07-07:00

Objective: To determine the frequency of thyroid disorders among children with obesity attending public sector hospital of Karachi, Pakistan. Study Design: Descriptive, Cross-sectional. Setting: Departments of Emergency and Outpatient, National Institute of Child Health (NICH), Karachi, Pakistan. Period: March 2024 to August 2024. Methods: A total of 193 children aged 5–16 years of either gender with obesity (BMI-for-age ≥95th percentile by WHO standards) were enrolled using non-probability consecutive sampling. Sociodemographic and clinical data were recorded. Fasting blood samples were analyzed for TSH, T3, and T4. Thyroid dysfunction was classified using standard TSH and FT3 and FT4 thresholds. Data were analyzed with SPSS using t-tests and Chi-square, considering p<0.05 significant. Results: Of the 193 obese children, the mean age was 11.1 ± 2.8 years, and 105 (54.4%) were boys. There were 135 (69.9%) children who were resided in urban areas, while 124 (64.2%) children had class 1 obesity, and 69 (35.8%) had severe obesity. The mean BMI z-score was 2.56±0.46. Thyroid dysfunction was detected in 35 children (18.1%). Severe obesity was significantly more common among those with thyroid dysfunction (45.7% vs 33.5%, p=0.011). Conclusion: Thyroid dysfunction was frequently observed in obese children, with the highest risk among those with severe obesity.

Is there need of routine histopathological analysis of cholecystectomy specimens.

2025-06-25T04:19:34-07:00

Objective: To determine the prevalence of incidental gallbladder carcinoma (GBC) and premalignant lesions in routine histopathological examination (HPE) of all cholecystectomy specimens at a tertiary-care hospital in Karachi. Study Design: Prospective Cohort study. Setting: Kulsoom Bai Valika Hospital. Period: April 2024 to April 2025. Methods: All adult patients (≥18 years) undergoing elective or emergency cholecystectomy were enrolled. Exclusions comprised preoperatively known or suspected GBC and lost specimens. Demographic, clinical, ultrasonographic, operative, and histopathological data were collected on 600 patients. Specimens underwent standard paraffin embedding, sectioning, and hematoxylin-eosin staining. Histological diagnoses were classified into chronic cholecystitis (with/without stones), acute cholecystitis, cholesterolosis, adenomyomatosis, adenoma, metaplasia (intestinal/pyloric), xanthogranulomatous cholecystitis, high-grade dysplasia/carcinoma in situ, and invasive carcinoma (staged T1a/T1b). Continuous variables are presented as mean ± SD; categorical variables as n (%). Group comparisons used Student’s t-test or chi-square/Fisher’s exact tests; p < 0.05 was significant. Results: Among 600 patients (344 elective, 256 emergency; mean age 48.0 ± 12.0 years; 72.7% female), chronic cholecystitis was predominant (411/600, 68.5%). Acute cholecystitis occurred in 107 (17.8%). Benign neoplasms and non-neoplastic lesions were infrequent: adenoma 0.8%, adenomyomatosis 3.8%, cholesterolosis 1.7%, cholesterol polyps 1.0%, and metaplasia 2.8%. High-grade dysplasia/carcinoma in situ was identified in 12 (2.0%). Incidental invasive GBC was found in 6 elective patients (1.0%; all T1 lesions). No carcinomas were detected in emergency cases. Emergency surgery was associated with higher white blood cell counts (14.65 ± 2.94 vs. 8.02 ± 2.93 × 10^9/L; p < 0.001) and fever (61.3% vs. 0%; p < 0.001). Conclusion: Routine HPE of all cholecystectomy specimens in this high-incidence setting identified early-stage GBC and premalignant lesions in a meaningful proportion (3.0%), justifying universal submission. Selective protocols risk missing occult neoplasia and should be applied cautiously in similar populations.

Comparison of post operative pain in self gripping mesh (PROGRIP) repair versus fixation of mesh in Lichtenstein repair for inguinal hernia.

2025-05-06T05:27:22-07:00

Objective: To compare post-operative pain outcomes between self-gripping mesh repair and prolene sutured mesh fixation in Lichtenstein repair for inguinal hernia at a tertiary care hospital in Karachi. Study Design: Randomized Controlled Experiment. Setting: Surgical Unit 3, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. Period: April 2023 to September 2023. Methods: A full six months of research were dedicated to the topic. Methodology: A total of 100 male patients aged 18 to 60 years undergoing elective inguinal hernia repair were randomly allocated into two groups: Group 1 received self-gripping mesh repair, and Group 2 received prolene sutured mesh repair. Pain scores were assessed post-operatively at 8 hours, 24 hours, and on the 5th day using the Visual Analogue Scale (VAS). Demographic and clinical data were analyzed using SPSS version 20, and comparison of pain scores between the groups was performed using the independent t-test with significance set at P < 0.05. Results: Total 100 patients admitted for inguinal hernia repair were included. The mean age was 31.840+3.606 years. The mean post-operative pain score (at 8 hours, 24 hours & at 5^thday) in group 1 was 4.640+0.631, 2.640+0.622 & 1.540+0.542 respectively while in group 2 it was 6.640+1.045, 5.580+0.730 & 3.780+0.932 respectively. Conclusion: In conclusion the mean post-operative pain in self gripping mesh repair was significantly low as compared to prolene sutured mesh repair. So self-gripping mesh repair method is superior over prolene sutured mesh repair method.

Diagnostic accuracy of sentinel lymph node biopsy in clinically node negative axilla after neo-adjuvant chemotherapy.

2025-09-04T07:16:33-07:00

Objective: To determine Diagnostic Accuracy of SLNB in a clinically node negative axilla after neo-adjuvant chemotherapy by taking ALND as gold standard. Study Design: Cross sectional study. Setting: Outpatient Department of Surgical Ward, Mayo Hospital Lahore. Period: 5^th August 2020 to 5^th March 2021. Methods: Including 43 patients with breast lump presenting in a six months duration after four cycles of neo-adjuvant therapy, restaging was done and primary surgery was performed along with SLNB followed by ALND. The hottest and blue nodes along with stained lymphatic were collected and sent for histopathology. Results: In this study sensitivity came out to be 94.6%, specificity 63%, positive predictive value of 97% and negative predictive value of 71%.Our diagnostic accuracy came out to be 93%. Conclusion: Based on the results of this study it can be concluded that SLNB should be done in all patients presenting with breast carcinoma and clinically node negative axilla to stage the axilla. It can prevent undue ALND.

From injury to evidence: Radiological evaluation of nasal bone fractures in medicolegal cases.

2025-09-11T04:08:20-07:00

Objective: To determine the characteristics in the demographic profile, the causes and radiological investigations used for diagnosis of nasal bone fractures of medicolegal cases. Study Design: Cross sectional study. Setting: Department of Radiology, Mayo Hospital, Lahore. Period: 1^st July, 2023 till 30^th June, 2025. Methods: All medicolegal cases of both genders and all ages with history of nasal fracture referred for radiological investigations are included in the study. Results: The study included 77 cases with nasal fractures. The age ranged from 15-60 years with mean age 35.84 ±11.59 years. The most affected group was 21-30 years (36.36%). Highest incidence of cases occurred in summer 42%. Most of the injuries 72 (94%) were sustained through physical violence. Conventional radiography was the investigation most commonly used to diagnose nasal fractures (81.81%). Conclusion: Nasal fractures are most common in males, in young age group. The most common cause is physical violence with higher prevalence in summer. Most of the cases are diagnosed on X-ray.

Investigating the combined effect of hyperlipidemia and other risk factors on heart diseases in diabetic populations: A systematic review.

2025-04-17T01:40:41-07:00

Objective: To investigate the combined effect of hyperlipidemia with other risk factors on incidence and outcomes of heart diseases in diabetic populations. Study Design: Systemic Review. Setting: Multinational Articles Selected. Period: Studies published from 2012 to February 2024. Methods: We searched PubMed, Embase and Cochrane Library up to February 2024 for prospective cohort studies and randomized controlled trials. Studies were included if they investigated the effect of hyperlipidemia along with one or more additional risk factors like hypertension, obesity, smoking etc. on cardiovascular outcomes in diabetic adult populations. Two reviewers independently screened the studies and extracted the data. Risk of bias was assessed using validated tools. Pooled effect estimates were calculated using random effects meta-analysis. Results: A total of 15 studies with 1,23,456 participants were included. The risk of cardiovascular events was significantly higher in diabetic patients with hyperlipidemia compared to those with diabetes alone (RR 1.56, 95% CI 1.34-1.82, I2=68%). Further, the risk was substantially increased in presence of additional risk factors like hypertension (RR 2.12, 95% CI 1.78-2.52), obesity (RR 1.98, 95% CI 1.62-2.41) and smoking (RR 2.47, 95% CI 1.92-3.18). Subgroup analyses showed a consistent effect across study designs and settings. Conclusion: Our systematic review provides robust evidence that hyperlipidemia significantly increases the risk of cardiovascular outcomes in diabetic populations. The risk is further magnified in the presence of other modifiable risk factors like hypertension, obesity and smoking. Tight control of all risk factors is needed for optimal management of cardiovascular health in diabetes.

Frequency of low HDL-C levels in patients suffering from acute coronary syndrome.

2025-04-15T05:12:54-07:00

Objective: To find out how often patients with acute coronary syndrome have low HDL-c values. Study Design: Cross-sectional study. Setting: Department of Cardiology, Faisalabad Institute of Cardiology, Faisalabad. Period: 29^th May 2021 to 28^th November 2021. Methods: Patients taking lipid lowering drugs, pregnant females and familial hyperlipidemia were excluded. Early morning fasting lipid profile along with HDL-c level was sent to hospital pathology lab. The reports were collected and interpreted by the researcher himself as per operational definition. Frequency of low HDL-c in patients of ACS was noted. Results: A total of 384 patients presenting in emergency with acute coronary syndrome of age 30-80 years of either gender were included. Age range in this study was from 30 to 80 years with mean age of 57.51±7.50 years. Majority of the patients 248 (64.58%) were between 56 to 80 years of age. Out of the 384 patients, 227 (59.11%) were male and 157 (40.89%) were females with male to female ratio of 1.4:1. Mean BMI was 30.67 ± 3.72 kg/m2. Frequency of low HDL-c levels in patients suffering from acute coronary syndrome was found in 172 (44.79%) patients. Conclusion: This study demonstrated that many of patients suffering from acute coronary syndrome have a low frequency of low HDL c levels.

Thermal status and clinical condition of referred neonates at arrival in a tertiary care referral nursery in Pakistan.

2025-10-09T05:48:21-07:00

Objective: To determine the thermal status and associated clinical conditions of referred neonates at arrival in a tertiary care referral nursery in Pakistan, and to assess their associations with short-term outcomes. Study Design: Observational Cohort study. Setting: Department of Neonatology, Children’s Hospital & Institute of Child Health, Faisalabad. Period: 1^st January to 30^th June 2025. Methods: A total of 355 consecutively referred neonates ≤28 days were enrolled. Axillary temperature was measured within 15 minutes of arrival. Other variables included gestational age, birth weight, mode of delivery, clinical colour, feeding ability, blood glucose, referral reason, oxygen support, and need for IV resuscitation. Outcomes at 48 hours were categorized as alive, expired, or left against medical advice (LAMA). Statistical analysis was performed using SPSS v26. Descriptive summaries and chi-square tests assessed associations (p<0.05 considered significant). Results: Of 355 neonates, 148 (41.7%) were preterm. Hypothermia was present in 112 (31.5%) including mild (28.5%) and severe (3.1%). Hypothermia was significantly associated with mortality (p=0.000). Hypoglycemia occurred in 41 (11.5%) neonates and was also linked to mortality (p=0.029). Oxygen delivery method and IV bolus administration were both associated with poor outcomes (p=0.000). At 48 hours, 275 (77.5%) survived, 65 (18.3%) expired, and 15 (4.2%) left against medical advice.
Conclusion: Hypothermia, hypoglycemia, invasive ventilation, and IV bolus administration were significantly associated with mortality among referred neonates. Findings emphasize strengthening of referral stabilization practices—thermal protection, glucose monitoring, safe oxygen delivery, and rational fluid therapy.

Delays in establishing permanent vascular access and referring new hemodialysis patients to a nephrologist: A single center study.

2025-09-10T08:07:49-07:00

Objective: To determine the frequency and causes of delayed nephrology referral and late vascular access creation in newly initiated hemodialysis (HD) patients at a tertiary care center in Peshawar, Pakistan. Study Design: Descriptive Cross-sectional study. Setting: Department of Nephrology, Lady Reading Hospital, Peshawar. Period: January 2025 to June 2025. Methods: A total of 248 adult patients with end-stage renal disease (ESRD) initiating maintenance HD were enrolled. Data regarding demographics, comorbidities, timing of nephrology referral, counseling for vascular access, type of vascular access at initiation, duration of delay, and patient-reported reasons for delay were collected. Delay in permanent vascular access creation was categorized as no delay, 1–3 months, 4–6 months, or more than 6 months. Data were analyzed using SPSS version 25, with Chi-square tests applied for categorical variables. Results: The mean age of patients was 52.6 ± 13.4 years, with 57.3% males. Hypertension (75.8%) and diabetes mellitus (53.2%) were the most common comorbidities. Diabetic nephropathy (35.5%) and hypertension (25.0%) were the leading causes of ESRD. At HD initiation, non-tunneled central venous catheters (ntCVC) were used in 49.2% of patients, arteriovenous fistulas (AVF) in 33.9%, tunneled CVCs (tCVC) in 16.5%, and arteriovenous grafts (AVG) in 0.4%. Only 21.0% of patients had no delay in permanent vascular access creation, whereas 31.5%, 25.0%, and 22.5% experienced delays of 1–3 months, 4–6 months, and more than 6 months, respectively. The most frequently reported patient-related reasons for delay were financial burden (26.6%), lack of awareness (23.4%), fear of pain (19.4%), denial of disease (16.1%), and family refusal (14.5%). Conclusion: A catheter-first approach predominates among incident HD patients, with substantial delays in establishing permanent vascular access. Both patient- and system-level factors contribute to these delays, emphasizing the need for early CKD detection, timely nephrology referral, structured pre-dialysis counseling, and streamlined vascular access pathways to improve outcomes.

Comparison of Surgical Site Infection (SSI) in Mesh vs Non-mesh repair of obstructed inguinal hernia in emergency setting.

2025-11-17T06:34:08-08:00

Objective: To compare the frequency of infection with and without mesh repair of obstructed inguinal hernia in Emergency Surgery. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Sahiwal Teaching Hospital, Sahiwal. Period: 1^st Jan 2024 to 30^th June 2024. Results: In group A, the average operating time was 62.20±11.35 minutes, whereas in group B, the average operative time was 57.54±11.84 minutes. There was no notable correlation between wound infection and study groups since the p-value did not reach statistical significance. The p-value is 0.29. There was no statistically significant difference in the average length of full healing between group A and group B, as shown by the non-significant p-value. The p-value is 0.238. Conclusion: This research concludes that there was no difference in the incidence of wound infection between those who had emergency surgery to treat an obstructed inguinal hernia with mesh and those who did not.