The Professional Medical Journal

Comparison of surgical outcomes of laparoscopic and open appendectomy for perforated Appendicitis: A clinical experimental study assessing surgical site infections, operative time hospital stay and postoperative recovery.

Mudassir Jabeen — 2025-09-04

Objective: To compare the frequency of SSIs, operative time, length of hospital stay, and time to return to routine activities between LA and OA in patients with perforated appendicitis. Study Design: Randomized Control Trial. Setting: Department of General Surgery, Allied Hospital, Faisalabad. Period: October 31, 2021, to April 30, 2022. Methods: A total of 230 patients, aged 15–50 years, with intraoperatively confirmed perforated appendicitis, were enrolled using non-probability consecutive sampling. Patients with negative appendectomy or non-perforated appendix on operation, pregnant females, immune-compromized and DM were excluded. Participants were assigned to undergo either LA (Group A, n=115) or OA (Group B, n=115). Consultant surgeons performed all procedures with at least three years of post-fellowship experience. Primary outcomes included SSIs (tracked for four weeks postoperatively), operative time (minutes), hospital stay (days), and time to resume routine activities (days). Results: The mean age of patients in group A was 34.60 ± 7.77 years and in group B was 35.61 ± 8.17 years. Majority of the patients 127 (55.22%) were between 15 to 35 years of age. Out of 230 patients 153 (66.52%) were males and 77 (33.48%) were females with male to female ratio of 2:1. SSIs occurred in 4.35% of patients undergoing LA versus 11.30% in the OA group (p=0.049). LA had a significantly longer operative time (74 ± 15 vs. 50.9 ± 15 minutes, p<0.0001) but resulted in a shorter hospital stay (2.4 ± 0.6 vs. 3.7 ± 2.5 days, p=0.03). A highly significant difference existed between 2 groups in time taken to return to normal routine activities, less in group A (LA) with means 14.4±3.1 vs 18.1±3.3 days with p value 0.0001. LA remained superior in reducing wound infections overall. Conclusion: In patients with perforated appendicitis, laparoscopic appendectomy significantly lowers the risk of SSIs, shortens hospital stay, and facilitates an earlier return to daily activities, despite a moderately longer operative time.

Efficacy and safety of oral minoxidil 5 mg in male patients with androgenetic alopecia.

Saira Muaaz — 2025-09-04

Objective: To determine efficacy and safety of oral minoxidil 5mg in male patients with androgenetic alopecia. Study Design: Non Randomized Clinical Trial. Setting: Department of Dermatology, Lahore Medical and Dental College/ Ghurki Trust and Teaching Hospital Lahore. Period: 14^th April 2022 to 31^st July 2023. Methods: It was a non-randomized clinical trial in which 30 male patients were enrolled according to inclusion criteria. Oral minoxidil 5mg once daily was given to patients for 24 weeks. This study was conducted at Department of Dermatology Lahore Medical and Dental College/ Ghurki Trust and Teaching Hospital Lahore with ethical letter no LM&DC/ 5363-64. Efficacy was measured by hair thickness, global photographic assessment and self-assessment questionnaire. Safety was measured by history, physical examination and laboratory investigations. Results: Two patients left treatment due to side effects (exacerbation of asthma and hypertrichosis) and 1 patient was lost to follow up. Therefore, total results were for 27 patients. Mean change in hair thickness was significantly increased from baseline 0.026±0.008 mm to 0.037±0.008 mm with p value 0.002 at 24 weeks. Global photographic assessment of patient’s scalp shows marked improvement. Patient self- assessment questionnaire showed satisfaction of patients with significant p value < .001. Side effects noted were hypertrichosis in 77% and mild headache in 7% patients. All laboratory parameters remained within normal range. Conclusion: Oral minoxidil is a safe and effective drug. It has significantly increased hair thickness and improved appearance in our patients.

Outcome of femoral shaft closed fracture treated by interlocking nail in patients presenting to a tertiary care hospital.

Wajid Ali — 2025-09-04

Objective: To evaluate the clinical and radiological outcomes of closed femoral shaft fractures managed with interlocking intramedullary nailing in patients. Study Design: Descriptive study. Setting: Department of Orthopedics, Hayatabad Medical Complex, Peshawar. Period: June 8 2023 to December 8, 2023. Methods: Using non-probability consecutive sampling, 70 patients with closed femoral shaft fractures, ages 18 to 70, were recruited. AP and lateral femoral X-rays as well as clinical assessment were used to diagnose fractures. Under spinal anesthetic, skilled orthopedic surgeons carried out the surgical fixing procedure. Callus bridging three cortices was considered radiological union, and the Thorensen criteria were used to evaluate functional outcomes. Six-month follow-up assessments were carried out. A p-value of less than 0.05 was deemed significant. SPSS version 20 was used to analyze the data, and chi-square tests were used for stratified comparisons. Results: Of the participants, 41.4% were female and 58.6% were male, with an mean age of 47.64 ± 14.03 years. 65.7% of patients had radiological union. Of the patients, 89.9% had an acceptable outcome, with functional outcomes being outstanding in 60.0%, good in 30.0%, fair in 7.1%, and bad in 2.9%. Results did not significantly correlate with smoking status, age, gender, diabetes, or hypertension. Conclusion: In closed femoral shaft fractures, interlocking intramedullary nailing is linked to a high percentage of radiographic union and satisfactory functional results. Comorbidities such smoking, diabetes, and high blood pressure had no discernible effect on the effectiveness of treatment.

Clinical outcome of closed intramedullary interlocking nailing in comminuted fractures of the femur.

Anas Ilyas — 2025-09-04

Objective: To determine the clinical outcome of closed intramedullary interlocking nailing in comminuted fractures of the femur. Study Design: Retrospective Study. Setting: Department of Orthopaedics & Spine Centre, Ghurki Trust Teaching Hospital, Lahore. Period: January 2022 to December 2022. Methods: The study included 50 patients who fulfilled the inclusion criteria. Patients with Gustillo Anderson Class I fractures, patients with pathological fractures, and patients aged 18 to 65 years of both sexes were included in this research. Patients with serious injuries were not included. The data was gathered via non-probability, sequential sampling. The patients had spinal anaesthesia for their operations after providing written informed permission. Three months after surgery, patients were evaluated again to determine the functional result using modified Klaus & Klemm criteria. SPSS version 25.0 was utilized for doing statistical analysis. Using stratifications, effect variables such as age, gender, and injury manner were controlled. A chi-square test after stratification was used to examine their impact on the result; A p-value is considered significant if it is less than 0.05. Results: The results indicate that the majority 90% were male patients and only 105 cases were females with the mean age of patients 33.34±13.87 ranging from 18 to 60 years. Road Traffic Accidents (RTA), comprising 64.0% of the total sample. Falls were the mode of injury for 8 cases, accounting for 16.0%. Other modes of injury were reported in 10 participants, representing 20.0%. According to clinical outcome, 33(44%) cases found with excellent functional outcome, 18(36%) with good, 8(16%) with fair and 1(2%) with poor outcome. Only the mode of injury was significantly associated with the clinical outcome as p<.05. Conclusion: The best treatment for comminuted long bone fractures in lower limbs is closed intramedullary interlocking nailing, which increases the chance of bone union and reduces disruption to the fracture pieces' blood supply. Other advantages of interlocking nails include a reduced length of hospital stay, early weight bearing, early muscle rehabilitation, early joint mobilization, and—above all—an early return to employment and pre-fracture status.

Frequency of vascular insufficiency in patients presenting with diabetic foot ulcer.

Bakhtawar Rafique — 2025-09-04

Objective: To determine the prevalence of vascular insufficiency in patients presenting with diabetic foot ulcers and analyze associated demographic and clinical factors. Study Design: Cross-sectional Observational Study. Setting: Department of Medicine, Ghulam Muhammad Mahar Medical Teaching Hospital, Sukkur. Period: October 2023 to March 2024. Methods: Included 122 patients aged 35–75 years, diagnosed with diabetes mellitus for at least one year, and presenting with diabetic foot ulcers. Vascular insufficiency was assessed using Doppler ultrasound and laboratory tests. Results: The prevalence of vascular insufficiency was 17.2%. No significant associations were found with gender (p = 0.524), age (p = 0.204), or duration of diabetes (p = 0.240). Hypertension, ischemic heart disease, and smoking also showed no statistically significant associations. Compared to regional and global studies, the prevalence was slightly lower, potentially due to population-specific characteristics and differences in diagnostic methods. Conclusion: Vascular insufficiency remains a prevalent concern among DFU patients, although the observed frequency was lower than reported in other studies. Early vascular assessment and targeted interventions are critical for improving outcomes and reducing complications in resource-limited settings.

Comparison of four airway assessment tools to predict difficult endotracheal intubation: A cross-sectional study to facilitate early-year residents in anesthesia training.

Sairah Sadaf — 2025-09-04

Objective: To assess four airway assessment tools to predict difficult airway to facilitate early year residents in anesthesia training. Study Design: Cross-sectional study. Settings: Sheikh Zayed Medical College & Hospital, Rahim Yar Khan. Period: September 2023 to October 2024. Methods: Enrolled 203 patients thru convenient sampling. Patients’ airways were assessed using ULBT, MMT, TMD, and SMD; four bedside airway assessment methods. And results were compared with laryngoscopic view (Cormack-Lehane) in terms of sensitivity, specificity, PPV, NPV and Accuracy. Results: A total of 203 patients participated, with mean age 36 years, and mean BMI 27.3kg/m². ULBT, MMT, SMD, and TMD predicted difficult airway in 10.8%, 15.3%, 6% and 9.9% of the patients, respectively. While Cormack-Lehane view presented difficulty in 15.3% intubations. These four airway assessment tools revealed a wide range of sensitivities, from 15.1% to 54.8%. Conclusion: Among all four tests, ULBT and MMT are superior in efficacy as compared to TMD and SMD in identifying a potentially difficult airway.

Influence of pre-operative infiltration of local anesthetics bupivacaine vs lignocaine vs tramadol on postoperative pain control following lichtenstein mesh hernioplasty.

Sheikh Abubakar — 2025-09-04

Objective: To evaluate the influence of pre-operative infiltration of local anesthetics bupivacaine V/S Lignocaine V/S Tramadol on postoperative analgesic pain control following Lichtenstein mesh hernioplasty. Study Design: Quasi-experimental Trial. Setting: Surgical Department, Ittefaq Hospital, Lahore. Period: Over four months, with an additional month for statistical analysis from March 2023 to July 2023. Methods: Ninety patients aged 18–65 years undergoing elective Lichtenstein mesh hernioplasty were randomized into three groups: Group A received tramadol 2 mg/kg, Group B received 0.25% bupivacaine, and Group C received 2% lignocaine for pre-operative local infiltration. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 2, 4, 6, 12, and 24 hours. The primary outcome was the duration of postoperative analgesia, defined as the time from completion of surgery to the first request for additional analgesia. Results: The tramadol group exhibited a significantly longer pain-free duration (12.25 ± 1.99 hours) compared to the bupivacaine (4.88 ± 1.30 hours) and lignocaine (3.81 ± 1.04 hours) groups (p < 0.001). VAS pain scores at all time points were consistently lower in the tramadol group. For instance, at 2 hours postoperatively, the VAS score was 2.09 ± 0.79 in the tramadol group, 3.68 ± 0.96 in the bupivacaine group, and 3.99 ± 1.26 in the lignocaine group (p < 0.001). No significant differences in adverse effects were observed among the groups. Conclusion: Pre-operative local infiltration with tramadol provides superior and prolonged postoperative analgesia compared to bupivacaine and lignocaine in inguinal hernia repair. Tramadol's cost-effectiveness and favorable safety profile make it a viable option for postoperative pain management, especially in resource-constrained settings.

Comparing the use of sevoflurane versus propofol for anesthesia induction during laryngeal mask airway insertion in outpatient urological surgeries.

Saima Zia — 2025-09-04

Objective: To compare the effectiveness of sevoflurane and propofol for anesthesia induction during laryngeal mask airway insertion in outpatient urological surgeries. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Fauji Foundation Hospital, Rawalpindi. Period: January 2022 to June 2022. Methods: A total of 60 patients aging ≥ 18 years, undergoing planned urological procedures were enrolled and randomized into two equal groups of 30 patients each. In Group P, induction was done using intravenous Propofol 2 mg/kg administered over 30 seconds. In Group S induction was done using Sevoflurane (8%) in 100% oxygen via a facemask. After achieving adequate conditions, LMA Classic^TM was inserted as per recommended technique. Primary outcomes included, the time for successful insertion of laryngeal mask airway, frequency of apnea and complications related to insertion and the post-induction mean arterial pressure. The outcomes of the two groups were compared by applying Chi-squared test and Independent t-test, taking p≤0.05 as significant. Results: The study participants had a mean age of 41.43±8.24 years, with males comprising 56.66% and females comprising 43.33% of total population. The results of study outcomes show that laryngeal mask airway insertion time was significantly higher in Group S compared to the Group P (p ˂0.0001). On the other hand, the incidence of apnea and complications related to insertion were significantly higher in Group P compared to Group S (p=0.03 & p=0.02 respectively). Regarding the hemodynamic findings, a significantly lower mean arterial pressure was observed at 6 minutes after induction in Group P compared to Group S (p=0.01). Conclusion: Sevoflurane offers fewer complications along with better hemodynamic stability despite longer laryngeal mask airway insertion time compared to propofol for outpatient urological procedures.

Comparison of tamsulosin with placebo in relieving ureteral stent related lower urinary tract symptoms.

Ghulam Abbas — 2025-09-04

Objective: To compare efficacy of tamsulosin verses placebo in relieving ureteral stent related lower urinary tract symptoms. Study Design: Randomized Control study. Setting: Department of Urology and Renal Transplant, Allied Hospital I/ Faisalabad Medical University, Faisalabad. Period: 1^st June 2024 to 30^th November 2024. Methods: Total number of 60 patients who underwent ureteroscopy and DJ stenting for ureteric stones were selected, and divided into 2 groups. Group A (administered with tamsulosin) and Group B (with placebo). IPSS score calculated at 21^th day after procedure. Scores of both groups were compared. Results: Patient of group A who were given tamsulosin had less lower urinary tract symptoms as compared to patient who received placebo drug. Conclusion: Tamsulosin significantly improved lower urinary tract symptoms caused by DJ stents.

Role of multidetector computed tomography (MDCT) in evaluation of congenital renal anomalies.

Humaira Riaz — 2025-09-04

Objective: To evaluate the role of Multidetector Computed Tomography (MDCT) in the detailed assessment, characterization, and classification of congenital renal anomalies along with associated complications. Study Design: Cross-sectional Descriptive study. Setting: Department of Radiology in the Institute of Urology and Transplantation (IUTR), Rawalpindi. Period: September 2023 to February 2024. Methods: A cohort of 38 patients aged 8 to 77 years was examined to investigate a spectrum of renal abnormalities. The diagnostic protocol comprised a comprehensive quad-phase examination using a state-of-the-art multi-detector-row CT scanner. The acquired images underwent meticulous evaluation by two experienced radiologists. Results: The mean age of the participants was 41.1 years. Among the 38 suspected cases, 24 exhibited normal kidney anatomy, while congenital renal anomalies were identified in 14 patients. Migration and fusion anomalies were observed in 5 patients, including 2 with crossed fused ectopia and 3 with horseshoe kidneys. Ectopic pelvic kidneys were diagnosed in 3 patients. Additionally, 2 patients presented with a duplex collecting system, one accompanied by a bifid ureter. Unilateral renal agenesis was found in 3 patients, with one female patient having a coexisting Mullerian duct anomaly. Conclusion: Multidetector CT (MDCT) emerges as a crucial diagnostic tool for congenital renal anomalies, offering insights into fusion, shape, and position abnormalities.

Evaluation of hepatic mass on ultrasound keeping triphasic multi detector computed tomography as gold standard.

Sikandar Abbas — 2025-09-04

Objective: To evaluate the diagnostic performance of ultrasound in identifying hepatic mass using triphasic multi-detector computed tomography (MDCT) as the gold standard. Study Design: Prospective Observational, Validation study. Setting: Department of Radiology, Combined Military Hospital, Gujranwala, Pakistan. Period: January 2024 to December 2024. Methods: The inclusion criteria were age between 18-80 years, and presenting with focal hepatic lesions greater than 2 cm in size (as per ultrasound). All patients subsequently underwent triphasic MDCT of the liver within a maximum of two weeks of the initial ultrasound. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of ultrasound compared to triphasic MDCT, were calculated. Receiver operating characteristics curves were drawn to calculate area under the curve (AUC) with 95% confidence interval. All statistical analyses were performed using IBM-SPSS Statistics, version 26.0. Results: In a total of 64 patients, 41 (64.1%) were males and 23 (35.9%) females. The mean age was 47.27±17.02 years, ranging between 18-80 years. Ultrasonography identified hepatic mass in 25 (39.1%) cases. The MDCT revealed positive findings for hepatic mass in 25 (39.1%) cases. Sensitivity, specificity, PPV, NPV, and accuracy of ultrasonography findings with respect to MDCT in diagnosing hepatic mass were 88.0%, 92.3%, 88.0%, 92.3%, and 90.6%, respectively. ROC curve analysis of ultrasonography findings taking MDCT as gold standard in diagnosing hepatic mass showed AUC as 0.902 with 95% CI of 0.813-0.990, p<0.001. Conclusion: The ultrasonography demonstrates high sensitivity and positive predictive value in detecting hepatic lesions, and serves as a valuable first-line modality.

Incidence of nuchal cord and its effect on mode of delivery and fetal outcome.

Sana Tariq — 2025-09-04

Objective: To determine the frequency of nuchal cord in term pregnancies and to evaluate maternal outcomes (cesarean section or vaginal delivery) and neonatal outcomes (low birth weight, poor APGAR score, or intra-partum loss) in patients with nuchal cord. Study Design: Descriptive Cross-sectional study. Setting: Department of Obstetrics and Gynecology, Maternal Newborn & Child Healthcare Unit, Faisalabad. Period: June 2024 to November 2024. Methods: Sample size of 369 term pregnancies (36–40 weeks). Patients were selected using non-probability consecutive sampling. Demographic details, nuchal cord presence, delivery mode, and neonatal outcomes (low birth weight and APGAR scores) were recorded. Data analysis was performed using SPSS version 26, with stratification for effect modifiers such as age, gestational age, parity, and number of cord loops. A p-value ≤0.05 was considered significant. Results: The frequency of nuchal cord was 24.4%. Maternal outcomes were not significantly affected by nuchal cord presence, as 72.2% of cases with nuchal cord had vaginal deliveries (p=0.199). Neonatal outcomes showed no significant relationship with nuchal cord presence: Low birth weight (<2.5 kg): 11.1% (nuchal cord) vs. 8.6% (no nuchal cord) (p=0.474). Poor APGAR scores (<7): 41.1% (nuchal cord) vs. 38.4% (no nuchal cord) (p=0.641). The number of cord loops did not significantly impact delivery mode or neonatal outcomes. Conclusion: Nuchal cord was common in term pregnancies but was not associated with adverse maternal or neonatal outcomes. Routine detection of nuchal cord should not prompt unnecessary cesarean sections. Future research should focus on multiple nuchal cords and their long-term neonatal implications.

Association of biophysical profile with APGAR score.

Uzma Riaz — 2025-09-04

Objective: To determine frequency of neonatal outcomes in neonates born to mother with good BPP score. Study Design: Descriptive Cross-sectional study. Setting: Department of Gynecology & Obstetrics Hilal -E- Ahmar hospital Faisalabad. Period: 30^th November 2020 to 29^th May 2021. Methods: A total of 385 pregnant women with age of gestation from 36 weeks to 42 weeks and 20 to 40 years of age were included. Patients with eclampsia and pre-eclampsia, IUGR, premature rupture of membranes, antepartum hemorrhage were excluded. Biophysical profile (BF) was calculated for all patients. Follow up was carried out till delivery where the type of delivery and APGAR score of neonates was noted, Neonates having APGAR Score of more than7/10 were labelled as having good APGAR score. Results: Mean age of patients was 28.48± 4.13 years. Majority of the patients 247 (64.16%) were between 18 to 30 years of age. In this study, frequency of neonatal outcomes in neonates born to mother with good BPP score was Good APGAR score in 338 (87.79%), Neonatal resuscitation in 45 (11.69%) and neonatal admission in 23 (5.97%). Conclusion: Frequency of good neonatal outcome in neonates born to mother with good BPP score was high.

Prevalence of exclusive breast breeding in postnatal ward at central park teaching hospital.

Esha Abdul Ghafoor — 2025-09-04

Objective: To determine the prevalence of exclusive breastfeeding (EBF) and associated factors influencing its practice among postnatal mothers at Central Park Teaching Hospital, Lahore. Study Design: Cross-sectional study. Setting: Conducted in the Postnatal Wards of Central Park Teaching Hospital, Lahore. Period: September 2023 to February 2023. Methods: Enrolled 150 mothers using a non-probability consecutive sampling technique. Structured face-to-face interviews using a pretested questionnaire collected socio-demographic, obstetric, and breastfeeding data. EBF was defined per WHO guidelines. Descriptive and inferential statistical analyses were performed. Results: The prevalence of EBF was 50.7%. No significant associations were observed between EBF and maternal age (p = 0.511), parity (p = 0.516), infant gender (p = 0.982), mode of delivery (p = 0.645), education level (p = 0.167), postnatal counseling (p = 0.071), breastfeeding initiation (p = 0.073), or maternal employment (p = 0.979). Trends suggested higher EBF rates among educated mothers, those receiving postnatal counseling, and those delaying breastfeeding initiations though statistical significance was not reached. Conclusion: Enhanced breastfeeding education and hospital-based interventions are needed. Although no significant predictors were identified, trends highlight potential influencing factors requiring further investigation. Future research should explore longitudinal and qualitative assessments to better understand maternal perceptions and barriers to EBF in Pakistan.

Post-CABG guidelines directed medical therapy: Assessing compliance at Peshawar Institute of Cardiology.

Muhammad Tariq — 2025-09-04

Objective: To determine the post-operative compliance with guideline directed medications following coronary artery by-pass grafting. Study Design: Retrospective Observational study. Setting: Peshawar Institute of Cardiology, KPK. Period: December 2020 to December 2023. Methods: This study included (n=2146) adults who underwent CABG surgery and their GDMT compliance was observed. Data was extracted from electronic medical record (EMR) and was evaluated by using SPSS version 26.0. Results: The mean age of the patients (56.821±10.1548) and mean BMI (27.8249±4.32135). Percentage of Guideline directed medical therapy utilization after coronary artery bypass grafting showed beta-blockers 97%, statin 95%, aspirin+clopidogrel to be 99%, aspirin 82%, ACEI 9% and CCB 5%. Multivariate regression model for secondary prevention in CABG, the rate of GDMT use, such as aspirin, showed a significant relationship with age (p < 0.05), while gender showed non significant relationship with GDMT use. Similarly, aspirin, CCB, and ACEI showed a significant relationship with family history (p < 0.05). Conclusion: The study underscores post-operative compliance with discharge medications following coronary artery bypass grafting (CABG). The findings revealed varying levels of adherence to guideline-directed medical therapies (GDMT), with several patients not fully complying with prescribed medications such as statins, beta-blockers, and aspirin.

Frequency of left atrial thrombus on transesophageal Echo in patients of severe mitral stenosis planned for PTMC (Percutaneous Transluminal Mitral Commissurotomy).

Muhammad Nouman Ahmad — 2025-09-04

Objective: To find out the frequency of LA clot in patients of severe mitral stenosis. Study Design: Cross Sectional study. Setting: Faisalabad Institute of Cardiology, Faisalabad. Period: July 2023 to April 2024. Methods: Non-probability consecutive sampling, Data analysis by SPSS version 25. Results: In this study total 180 patients included with 39% were male and 61% female. 60% patients were in atrial fibrillation. LA clot was found in 24% patients. Out of these 24% patients 79% were in atrial fibrillation. Conclusion: Clot in LA is quite common entity with every fourth patient having it. Patients with higher NYHA class and without warfarin are more prone to develop LA clot.

Comparison of GCS and four scoring system in prediction of mortality in ICU admitted patients.

Syed Muhammad Naveed Zafar Zaidi — 2025-09-04

Objective: To determine diagnostic accuracy of GCS and FOUR score in predicting mortality keeping actual mortality as gold standard. Study Design: Cross Sectional (valudation) study. Setting: Department of Pediatrics, Children Hospital Faisalabad. Period: September, 2024 to March 2025. Methods: We included three hundred fifteen children with neurological disorders who were admitted to the pediatric intensive care unit (PICU). The GCS and FOUR score findings were documented as clinical examination evidence in the PICU. The FOUR score and GCS score were calculated for each patient. Responses were documented using clinical examination of ocular, motor, verbal and brain stem reflexes. Mortality was assessed over a 7-day follow-up period. Results: Patients' mean GCS and FOUR score at admission were 8.66±1.6 and 11.69±2.37, respectively, and the mean PICU stay was 6.57±2.33 days. The mean age 6.77±2.84 years. The proportion of male patients (54%) was greater than that of female patients (46%). One hundred one patients (32.1%) died. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rate in predicting mortality using the Full Outline of Unresponsiveness Score (FOUR score) in children admitted to the PICU were 67.33%, 88.79%, 73.91%, 85.2%, and 81.9% respectively. On the other hand, GCS sensitivity, specificity, PPV, NPV, and accuracy rate are 63.37%, 84.58%, 65.98%, and 83.03%, respectively. Conclusion: The FOUR and GCS show good results with respect to mortality within a week after admission to the pediatric intensive care unit.

Improvement of left ventricular function after CABG in patients with poor left ventricular function.

Muhammad Mujahid — 2025-09-04

Objective: To determine frequency of improvement of left ventricular ejection fraction (LVEF) after CABG surgery in patients with poor left ventricular function preoperatively. Study Design: Cross-sectional study. Setting: Department of Cardiac Surgery, Faisalabad Institute of Cardiology, Faisalabad. Period: 10^th November 2022 to 9^th October 2023. Methods: Patients with poor Left ventricular function (LVEF) determined by echocardiography or angiography were confirmed by Multigated Acquisition (MUGA) scan pre operatively. They were admitted in cardiac surgery ward, where baseline investigations were done for planned CABG. After surgery they were followed up and there LVEF was determined by repeat MUGA scan at 3 months. Results: Frequency of improvement of left ventricular function (LVEF) after CABG in patients with poor left ventricular function preoperatively was recorded in 13.85%(n=9). Conclusion: Frequency of improvement of left ventricular function (LVEF) was not very higher after CABG in patients with pre operative poor left ventricular function. However, our results need validation through multicenter trials.

Blood pressure percentile of different age group of patients with congenital adrenal hyperplasia.

Wafa Nisar — 2025-09-04

Objective: To determine the mean blood pressure (BP) of patients with congenital adrenal hyperplasia (CAH) presenting to tertiary care hospital. Study Design: Cross-sectional study. Setting: Outpatient Department of Pediatrics, National Institute of Child health, Karachi, Pakistan. Period: June 2024 to November 2024. Methods: A total of 49 children of either sex, aged 5 to 15 years and established cases of CAH were analyzed. Demographic and clinical history of all the children were recorded at enrollment. Systolic and diastolic BP were measured thrice in succession at 1-minute interval, utilizing a mercury sphygmomanometer after the child had rested for a minimum duration of 10 minutes. Data were analyzed on “IBM-SPSS Statistics, version-26.0”. P-value <0.05 was used as statistically significant. Results: In a total of 49 children, 27 (55.1%) were female. The mean age was 8.85±2.87 years. The mean SBP, and DBP were recorded to be 120.02±18.19 mmHg, and 78.43±11.61 mmHg, respectively. Relatively older age group (11-15 years) was found to have significantly higher SBP (128.13±15.34 vs. 116.09±18.37 mmHg, p=0.028). Bivariate correlation analysis revealed significantly positive correlation (p<0.001) of SBP with age (r=0.636), height (r=0.654), weight (r=0.733), and body mass index (BMI) (r=0.700). DBP was having significant correlation (p<0.001) with age (r=0.577), height (r=0.645), weight (r=0.691), and BMI (r=0.606). Conclusion: Children with CAH exhibit elevated blood pressure levels, particularly with increasing age, height, weight, and BMI, underscoring the importance of regular cardiovascular monitoring in this population.

Frequency of electrolyte imbalance in neonates receiving phototherapy.

Ramsha Mehmood — 2025-09-04

Objective: To determine the frequency of electrolyte imbalance in neonates receiving phototherapy. Study Design: Cross Sectional study. Setting: Department of Pediatrics, National Institute of Child Health (NICH), Karachi, Pakistan. Period: July 2024 to December 2024. Methods: A total of 192 neonates between 2^nd and 14^th day of life, and presenting with jaundice and hyperbilirubinemia (total serum bilirubin>5 mg/dl) were analyzed. Demographic details were documented. Blood samples were sent for the evaluation of baseline serum bilirubin, and electrolyte levels. Duration of phototherapy was 48 hours. Post-treatment after 48-hours, serum bilirubin, and electrolyte evaluation was performed. Results: In a total of 192 neonates, 105 (54.7%) were male. The mean age, and gestational age were 8.24± 2.61 days, and 38.5±1.44 weeks. After 48 hours of phototherapy, a significant reduction was observed in total bilirubin (p<0.001), direct bilirubin (p<0.001), and indirect bilirubin (p<0.001). After 48 hours of phototherapy, decrease in the proportion of neonates with normal levels was observed for sodium (82.3%, p=0.736), chloride (77.6%, p=0.776), calcium (80.7%, p=0.475), potassium (81.8%, p=0.302), and magnesium (87.5%, p=0.195). The proportion of hypocalcemia increased from 14.6% to 18.8%, hypokalemia from 10.9% to 15.6%, and hypomagnesemia from 8.9% to 12.5%. Conclusion: This study highlights the effectiveness of phototherapy, and its potential to cause electrolyte disturbances. While the reductions in serum sodium, chloride, calcium, potassium, and magnesium levels were statistically significant, their clinical relevance remains uncertain.

Comparison of efficacy of intravenous ceftraixone versus oral azithromycin in uncomplicated enteric fever.

Asma Majeed — 2025-09-04

Objective: To compare the efficacy of intravenous ceftriaxone vs oral azithromycin in uncomplicated enteric fever. Study Design: Prospective Cohort study. Setting: Department of Pediatric, The National Institute of Child Health Karachi, Period: 23 January 2024 to 22 July 2024. Methods: 160 patients presented with uncomplicated enteric fever were distributed randomly in ceftriaxone and azithromycin group. Children in the ceftriaxone group received the dose of 75 mg/kg/day intravenously in 2 divided doses, while children in the azithromycin group received the dose of 20 mg/kg/day as a single oral dose for 7 days. Clinical and microbiological efficacy were confirmed on resolution of all symptoms and negative blood culture for Salmonella typhi, respectively. Results: Clinical cure was significantly (p-value = 0.027) higher with oral azithromycin than with intravenous ceftriaxone [77 (96.3%) vs. 68 (85.0%)]. Microbiological cure was significantly (p-value = 0.028) higher with oral azithromycin than with intravenous ceftriaxone [80 (100.0%) vs. 74 (92.5%)]. The mean duration to become afebrile after initiating treatment was also significantly (p<0.001) shorter with oral azithromycin than with intravenous ceftriaxone [3.98 ± 0.80 days vs. 5.40 ± 1.62 days]. Conclusion: Oral azithromycin is more effective than intravenous ceftriaxone in the management of uncomplicated enteric fever with respect to clinical cure, microbiological cure and duration to become afebrile.

To access the empathy communication skills in house officers and post-graduate doctors. A cross-sectional study.

Afsheen Roomi — 2025-09-04

Objective: To assess young physicians' non-technical abilities, such as empathy, communication, and flexibility for providing quality patient care, this study aims to look into residents' empathy and communication skills toward patients and their caregivers. To ascertain how well non-technical skills are assessed using evaluation instruments in resident training programs. Study Design: Cross-sectional study. Setting: CMH Lahore Hospital. Period: January 2024 to March 2024. Methods: Design using purposive sampling was used to assess the non-technical skills of resident physicians. A modified Parents scale, was used to gather data. With a reliability of 0.884, the modified Parents scale had excellent internal validity and reliability. Using SPSS-26, we analyzed data gathered from 63 patients or their caregivers. Results: With a mean score of 1.54 and a standard deviation of 0.643, house officers and residents received outstanding ratings for their capacity to have relaxed discussions with patients and their caregivers. With a mean score of 1.33 and a standard deviation of 0.741, they were likewise highly rated for showing off their identity badges. Conclusion: Although respondent experiences vary significantly, resident physicians are frequently given positive scores for a number of competencies. Work needs to be done in the areas of discussing potential adverse effects, outlining treatment strategies, and consistently demonstrating empathy.

Hand washing measures and palmar bacterial floral susceptibility to antibiotics in a Tertiary Care Hospital, Peshawar.

Maria Khan — 2025-09-04

Objective: To examine the practice of handwashing, the microbial pattern, and the susceptibility of microorganisms isolated from the palms of healthcare workers at a Specialized Cardiology hospital in Peshawar, Pakistan. Study Design: Cross-sectional Observational study. Setting: Peshawar Institute of Cardiology- Medical Teaching Institute (PIC-MTI). Period: 1^st August till 31^st September, 2023. Methods: Both qualitative and quantitative methods were used to retrieve data. A self-administered questionnaire was utilized to gather respondents' practice scale of handwashing. Culture-based and biochemical tests were carried out to identify bacterial isolates, and the Kirby-Bauer Disk diffusion method was used to determine the susceptibility pattern of bacteria. Results: The majority of the respondents were between the ages 25 and 58, with 63% being male. Almost all Healthcare personnel used an alcohol-based hand sanitizer, while only 45.3% of respondents admitted to always using soap to wash their hands. Presumptive identification of the organisms showed 43.1% of organisms as Staphylococcus epidermidis and 16.8% as Micrococcus spp. Only 5 isolates of Methicillin-resistant Staphylococcus aureus (MRSA) were recovered. None of the antibiotics was 100% effective. The sensitivity to chloramphenicol was high (83-91%), and more than 80% of the isolates showed resistance to Amoxicillin-clavulanate, tetracycline (37-73%), Fusidic acid (36%), and clindamycin (36%). Resistance to erythromycin was seen in 62% of organisms tested, and only 15% were resistant to Rifampicin. Conclusion: This study highlights the importance of proper hand washing awareness and monitoring among hospital staff. There were many instances of poor hand hygiene, which could accelerate the transmission of microbes through hand contact. Moreover, there was high resistance observed to the tested antibiotics.

Outcome of management of subglottic stenosis Grade I, II (Cotton-mayer Grading System) using radiofrequency coblation.

Muhammad Salman Aslam — 2025-09-04

Objective: To find the outcome of management of subglottic stenosis Grade I and II (Cotton-Mayer grading system) using radiofrequency coblation. Study Design: Descriptive Case study. Setting: Lahore General Hospital, Lahore. Period: 08-02-25 to 07-05-25. Methods: Over three months we assessed the outcomes of radiofrequency coblation in managing Grade I and II subglottic stenosis (SGS). A total of 189 patients aged 20–60 years were selected. Inclusion was based on CT and endoscopic confirmation of Grade I (0–50%) or Grade II (51–70%) SGS. Patients with prior SGS surgery, pregnancy, or significant comorbidities were excluded. Voice outcomes were assessed using the Voice Handicap Index (VHI-30), and swallowing function was evaluated using the Eating Assessment Tool (EAT-10). Results: Of 189 patients 53.4% were aged 41–60 years, and females made up 58.2% of the sample; Grade I stenosis was slightly more common than Grade II. Regarding treatment outcomes, only 10.6% required retreatment. The mean age was 40.22 years, with average VHI and EAT-10 scores of 19.10 and 5.12, respectively. Conclusion: Radiofrequency coblation is a safe and effective modality for managing Grade I and II subglottic stenosis. Radiofrequency coblation showed acceptable outcomes on voice and swallowing related quality of life. The lack of significant association between age, gender, or stenosis grade suggests consistent efficacy across patient subgroups.

Diagnostic accuracy of magnetic resonance imaging in diagnosing and classifying fistula in ANO taking surgical findings as gold standard.

Shamoona Rashid — 2025-09-04

Objective: The gold standard for assessing the diagnostic precision of magnetic resonance imaging in identifying an ano fistula is surgical findings. Study Design: Comparative Cross-sectional study. Setting: Department of Radiology, Aziz Fatima Medical and Dental College, Affiliated Hospital, and Allied Hospital Faisalabad. Period: November 2024 to March 2025. Methods: Eighty patients, of either gender, aged 25–70 years, with suspected fistual symptoms lasting more than four weeks, were included. The following patients were not included: those with a history of perianal fistula surgery and those who were contraindicated for MR imaging due to cardiac. They were evaluated with pelvic magnetic resonance imaging (1.5T) utilizing a phase array coil without intestinal preparation. Patients were placed in a supine position for the purpose of acquiring images. To ascertain the presence and grade of the fistula, the consultant radiologist assessed the MRI findings. The MRI results and the surgical results were compared after surgery was performed in the relevant ward. Results: Overall MRI sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy are used to determine the ano fistula using surgical findings as the gold standard were 90.80%, 90.0%, 91.62%, 89.06%, and 90.44%, respectively. Conclusion: According to the study's findings, magnetic resonance imaging has a fairly high diagnostic accuracy when used to evaluate perianal fistulas prior to surgery.

Evaluation of determinants affecting the explanation of titanium osteosynthesis plates in maxillofacial trauma management.

Maryam Gul — 2025-09-04

Objective: To evaluate determinants affecting the explanation of titanium osteosynthetic plates in maxillofacial trauma management. Study Design: Cross-sectional. Setting: Lady Reading Hospital, Peshawar, Pakistan. Period: January 2018 to December 2022. Methods: The study included 250 patients with maxillofacial fractures who underwent treatment with titanium plate fixation. The patients’ demographic, clinical, and surgical variables were analysed using SPSS. Results: Plate removal occurred in 20% of cases (50 plates out of 250). The most common causes were: an infection (18 out of 50, 36.4%); persistent pain (14 out of 50, 28%); and request of the patients themselves (14 out of 50, 28%). Assault related injuries constituted a striking 42% (21 out of 50) of removals (p=0.003) while the association of miniplate use with 64% (32 out of 50) of the explantations is statistically significant (p=0.01). The use of titanium alloy plates had significantly lower removal rates (16 out of 50, 32%) compared to pure titanium (p=0.02). Conclusion: The risk of infection, the type of plate used, and the mechanism of trauma all significantly impact explantation rates. These results substantiate multi-level bespoke strategy formulation with a focus on high-risk scenarios that use miniplates or those resulting from assaults.